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f1 <br /> 04/15/2002 14:56 2090' '18 AGE; STOCKTON r" PAGE 01/01 <br /> DATE RECEIVEfl 1:;.0 L.0 HUMM. <br /> SAN AQU1N COUNTYPUBLIC HEALTHRVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> s 304 EAST WEBER AVENUE,THIRD FLOOR <br /> I STOCKTON CA 95202 <br /> (209)4683420 <br /> -4A4 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A41.1CAN7 �BL151I4ESSIAGENCY + <br /> !ADDRESS Sj2 yj Rood <br /> ' 11 <br /> FACSIMILE r ! /,� ` ;) •:r <br /> 36 TENTATIVE'APPOINTMENT DATE. T1M1= <br /> (Please v i bus6h ys Fromto of app cation submittal) <br /> CHECK BOX 70 EXPEDITE REQJU T-$ 8. 0 FE I— E TPA 1 BUSINESS DAYS <br /> 'SIGNATURE OF APPLICANT PATE / IJ <br /> t FILE ADDRESS <br /> unQW <br /> �- ol'7 0 II V <br /> ' 1A9 u v- 3� <br /> is LL � r■ u <br /> -c 3 Ste, S 2 <br /> CCC <br /> r n S� 3sz8 <br /> r n a 3s�I, <br /> 3sa8 >� 24 <br /> ENVIRONMENTAL HEALTH-DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNET. 0 DAIRY <br /> :f HAZARDOUS WAST:GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> i TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL 0 PUMPER IV <br /> TRUCYARD/CHEM TOILETS <br /> ❑ LAND USE APPLICATION SITES <br /> O TATTOOIBODY PEIRCING C3POOIISPA <br /> ❑ MEDICAL WASTE FACILITY _ 17 PUBLIC WATER SYSTEM G1 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in tl'e space above. Select the typa(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 m it to the <br /> address indica d above. <br /> 2. EHD will notify the applicant H 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 /> i will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> i 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A now <br /> appllication may be submitted when the file Is available. <br /> 4, Any fife 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 reRuirB a$78.00 deposit prior to review. <br /> '= 5. "TENTATIVE appointment dates must be-confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next lousiness day. <br /> .I <br /> t CONFIRMED APPOINTMENT DATA ; TIME <br /> E; <br /> DATE CONFIi2MED _ PHONE FAX INCfIAL$ <br /> ? REVIEWED YES NO REVIEW DATE <br /> EH 00 14 ailasmu <br /> S <br /> L <br />