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04 / 15/ 2002 14 : 56 2094r` -\118 AGE STOCKTON - aNuLwNUMUAGE 01 / 01 <br /> DATE NECEIY[0 <br /> N SAN .IOAQUIN COUNTYPUBLIC HEALTH . RVICES� <br /> ENVIRONMENTAL HEALTH DIVISION 2 <br /> 304 EAST WEBER AVENUE , THIRD FLOOR <br /> S STOCKTON CA 95202 <br /> (209) 468-3420 <br /> ., , PUBLIC RECORDS RELEASE APPLICATION <br /> I ° '47AUA1YIBUSINESS/AGENCY o <br /> Af <br /> ADDRESS SAI,204 <br /> PHONE <br /> ad9 ) yLa iDd� FACSIMILE <br /> TENTATIVE' APPOINTMENT DATE 190 ! i L O a TIME CJ �V 4� <br /> (pie $8 V 1 bust ys from to of app ication submittal) <br /> CHECK BOX TO EXPEDITE REQ T - 1 8, 0 FEE TP I BUSINESS DAYS C� <br /> I SIGNATURE OF APPLICANT t PATE / <br /> c <br /> FILE ADDRESS <br /> r JYJ /1 C Una L L <br /> 1/ l '7 d 'r v <br /> C/ s t <br /> v 4 3s L <br /> ,c _ D 3524 5 e29s <br /> !d n m CCC <br /> I h Sr- 3sz8 <br /> r n a 3sz t, <br /> r 35 .4 <br /> 35x8" K 24 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND YANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILIYY CI SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MpNITORINOIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYAR I/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOIJSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ DTHER (pLBASE 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 /> 24 EHD will notify the applicant It 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 now <br /> application may be submitted when the file Is available. <br /> 4. Any filo 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 /> 51 '"TENTATIVE appointment dales must be confirmed with EHD staff. <br /> 6. Applications received after 3'00 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 /> EN 00 14 0llostuo <br />