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SAN )AQUIN COUNTYPUBLIC HEALT ����'���""M°�" <br /> -� ,�,..iERVICES � <br /> v <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JAN 0 6 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 I <br /> HF-1LIH (209) 468-3420 <br /> FS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ' ��� � �` � b ' L --— -- <br /> I O BUSINESSIAGENCLY_ CQh6f'j lin 4,kkinl j <br /> ADDRESS <br /> PHONE — S /DO FACSIMILE /0 Z <br /> TENTATIVE"APPOINTMENT DATE <br /> (Plaaso 91vo 7 to 10 buslnoss days from data ofapplication al on submittal) <br /> ° 3CHECK BOX TO EXPEDITE REQUEST-$09.00 FEE-REQUEST PROCESSED IN J BUSINESS DAYmn . f <br /> SIGNATURE OF APPLICANT r <br /> DATE <br /> FILE ADDRESS , <br /> TF115 SIDE EHD STAFF USE ONLY <br /> ¢ PROGRAM ELEMENTS SEARCH <br /> '2�S(h' I 4'oA)e- #Cu.j�1 S-f n :Tu,f 1 j.Lam«, <br /> 1 <br /> WL <br /> Lac /Pto- glxv�/ roc' <br /> ENVIRONMENTAL HEALTH DIVISION FILES cf-CAY1 —P 7 <br /> ��t1NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> p'OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) O DOG KENNEL O DAIRY 7 ; <br /> d HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> C3 TIERED PERMITTED FACILITY O MOTEUHOTEL O PUMPER TRUCKNARD/CHEMO TAT BODY T <br /> O <br /> O MEDICAL WASTE FACILITY SPA QLAND USE APPLICATION SITES <br /> ❑ PUBLIC WATER SYSTEM M OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ton addresses In the space above. Select the types) 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 geld 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 ih the same condition as released will be reorganized by EHD staff at the expense <br /> Of the applicant. Future file reviews by the samo applicant may require a $89.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YESNO <br /> REVIEW DATE <br /> — <br />