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UA I 1�KtctivEo <br /> L:HU LUG NUMBER <br /> Mu <br /> C <br /> � ;$A. N J04QUIN COUNTYPUBLIC HEALTH S`RVICES <br /> o <br /> a ` F�,—, 4 �.,JVIRONMENTAL HEALTH DIVISII,,,,r <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> MAR 2 8 2000 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> N'✓iiriC�l�w�l�f ila.�. : Ii-APOUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT &N BUSINESS/AGENCY I, Q( � V, O-V\CW SOn <br /> ADDRESS ao,� 367-370) <br /> N(�c__AOn Lv*I <br /> PHONE dtq_ c 6 Z-3ZO) FACSIMILE cr,�y3l3,,3- I?3U <br /> TENTATIVE*APPOINTMENT DATE Apf, � 3 - 7 , DMO TIME 7��O(/ Q W <br /> (Please give 7 to 10 business days froYn date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �. DATE -3 0 O <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> b - 9 <br /> 'nil- I <br /> ENVIRONMENTAL HEALTH DIVISION FILES 0 <br /> .UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT dSOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ElDAIRY <br /> HAZARDOUS WASTE GENERATOR, ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 02/24/00 <br />