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02/12/2003 15:59 209467134,8 AGE STOCKTON PAGE 01/01 <br /> SAN .,�QUIN COUNTYPUBI_IC HEALTH RVICES V <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1; ,°� " ' 304 EAST WESER AVENUE.THIRD FLOOR <br /> � u3 STOCKTON CA 95202 <br /> F 1 N 2� (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIC^ANY"1 USINESS/AGENCY l-C�LIBfJ ��A-»nIIIIJ� <br /> ADDRESS ct <br /> PHONE (Ota f 9 ID6 FACSIMILE: <br /> TENTATIVE''APPOINTMENT DATE TIME V 1N A � <br /> (Please give 7 to 10 business days from date of application submittal) e <br /> CHECK SOX TO EXPEDITE RE QU SI�4 00 FEE—REQUESTMR SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> z- <br /> FILE ADDRESS <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(USI)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE F lLIf r++' <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> X..UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL Cf DAIRY <br /> •HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br /> ❑ PKG TREMMENT PLANT <br /> O TIERED PERMrrTED FACILITY ❑ MOTEUHOTE:L ❑ PUMPER TPLICK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING 0 POOL/SPA Q LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLI�ASE 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 ind(cal!;d above. <br /> 2. FHD 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 de p or ► roMew. <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. wly <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITLA,LS <br /> REVIEWED YES NO REVIEW DATE <br /> KH 99 14 91AMM <br />