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86/28/2802 12:07 269467111.8 AGE STOCKTON PAGE 02162 <br /> DATE RECEIVED - 1� AHP I.GG NUMBER <br /> SAN 1 QUIN COUNTYPURLIC HEALTH ' <br /> FtVICES <br /> ���J•r ENVIRONMENTAL HEALTH DIVISION <br /> .304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT SUSINE=SSIAGENCY <br /> ADDRESS /'� G� I <br /> PHONED DGJ FACSIMILERDO <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST•$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT (.t22 DAT£ <br /> AL <br /> - —----- <br /> 1 <br /> FILE ADDRESST7(1 4Aaj-L& <br /> I <br /> 1 <br /> �� Iota <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> i <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP 5172:(NON-LOP) Q FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) M 40G K><NNCL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIl RCD lir-RMITTED FACILITY ❑ MOTELIHOTEL r7 PUMPER TRUCKIYARDICHEMi TOILETS <br /> d TATT001BODY PEIRCING ❑ P00IJ9PA CI LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM OTHER(PLEASE SPECIFY ABOVE) f <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(ez). At least one file type MUST be selected. Fax to (2051464-0138 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 />'4 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 /> G. Applications received after 3:04 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 0116SMO i <br />