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12/07/2001 11:42 '3092733340 OFFICEMAY, H 0627 PAGE 01 <br /> DATE RECEIPED PHO LMNOMMR <br /> SAN MAQUIN COUNTYPIJBLIC HEALTHRVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> I� h 304 EAST WEBER AVENUE,THIRD FLOOR V <br /> (� STOCKTON CA 95202 <br /> (209)468-3420 <br /> p PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ` e'C e\V\0001 BUSINESSIAGENCY Mott <br /> ADDRESS �r_..)- 1� ��-TN \VfcQSIDE RVE F+\AL"CCJ I,.,G�A/• �'�3-f7 <br /> PHONE <br /> TENTATIVE"APPOINTMENT DATE ���1��•��Z TIME <br /> (Please OFre 7 to 10 business days from date of application submittal) <br /> U101 TS <br /> 171 CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE-REQUES OC SSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT =L �r r� e DATE %2\7 `�� k <br /> FILE ADDRESS <br /> 1N oar rtz.L�r�r P N <br /> \\bgs wlEst wP �Sccc ccN !v - <br /> � oQO P'E-CQEyi_ta>.1Yti GomPANY n C o H G <br /> �3 AVY OtiluF Tr�r'ir�-T-or� ' <br /> L..11CA C.o --t�of� � •� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 34 NDERGROUND TANK(UST)CLEANUP SITE(LOP) El HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> VtITHER CLEAN U P 9RE(NON-LOP) 11FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PER611TrED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOt_ETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILFTY ❑ 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{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 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 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:04pm 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 W 14 01MLW <br />