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SAN J QUIN COUNTYPURLIC HEALTH F WCES <br /> -'I 'ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> MAY 2 2001 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ".'-:,L1 F1 PUBLIC RECORDS RELEASE APPLICATION <br /> ..:. :IT wJr.. . <br /> APPLICANT ^ 4' :f ` k—f gff- BBUSINLSS/AGENCY CUY/d4Y <br /> ADDRESS I�'yYI(r7k'I,{/CJr'�YcA< V ccr 7 f <br /> PHONE FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE �I1? 0 f TIME o `/ <br /> (Pleme give 7 to 10 business days from dare o aPPIIc oon submittal) 'tfI <br /> CHECK BOX TO EXPEDITE REQUEST-$A7.00 FFEEEE—RREE]Q.UUEEST PROCESSED IN S BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT /� ` fir,c�""` DATE �/_/� <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ,2901. <br /> e e ro 14-- 14" Aid f <br /> 0 1 c i t f•Ls.e /J <br /> 1It .234/, -2 lZil 24 .13 c Z 86, o <br /> 5�r c .2227 <br /> Jc � >7 �22c X39 <br /> i <br /> �., <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 4a/UNDERGROUND TANK(UST)CLEANUP SITZ;(LOP) ❑ HOUSING ABATEMENT PC SOLID WASTE FACILrrY <br /> ,K_OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> J�UNDERGROUND TANK(MONITORtNG/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDJCHEM TOILETS <br /> ❑ TATTOOIBODY FORCING ❑ POOLISPA - /r 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 (20 9) 4114-01 3 8 or mail tD 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 EEID 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 revlews by the same applicant may require a $87.00 deposit prior to review. <br /> S. '"TENTATIVE appointment dates must be confirmed with ENI) staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONE MED PHONE_ FAX INITIALS <br /> REVIEWE YES NO REVIEW DATE <br />