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TO 17er42y4162 r . e2 <br /> EHO LOG NUMBER <br /> GATE RECEIVEDSAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES-- T24" <br /> ENVIRONMENTAL HEALTH DIVISION CPE <br /> .r 4 <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 JUN - 8 2000 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIOIANII (CINVIENIAL HEALTH <br /> /� / / /^ �° I rSk4iVIL <br /> 2kj (e. Yl <br /> O_ 6e,& BUSINESS/AGENCY <br /> APPLICANT � � ` L��e� / K <br /> ADDRESS Z ZS' mi r- 44c � 5-fa -�° n CA <br /> (� <br /> PHONE �� ' -I4S ,F^ACSIMILE ! ov O & ZI �( <br /> TENTATIVE" APPOINTMENT DATE <br /> ((/' ©� TIME LO .000 Amm <br /> t�71/ (Please Diva 7 to 10 business days from date of appijeatlan submittal) <br /> t{?l CHECK BOX TO EXPEDITE REQUEST - 8.00 FEE - RE EST P CESSED IN 3 BUSINESSDAYS <br /> G <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> Hill NINE <br /> WE FILE ADDRESS <br /> MONOMERa a <br /> o + . II Et, t it <br /> 2 k- s It tl n <br /> (I U I <br /> L <br /> C , L n . (� <br /> 56 7 Slc vL;, - 5c-it I °# <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> LF! UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> M�' THER CLEANUP SITE (NON-LOP) 17 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> WO UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> rH� <br /> HAZARDOUS WASTE GENERATOR 13CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> I�IERED PERMITTED FACILITY ❑ MOTEVHOTEL l7 PUMPER T APPLICATION SIM <br /> TOILETS <br /> O TATTOO/BODY PEIRCING - 00OOIJSPA. ❑ 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 (209) 464-0138 or mail to the <br /> addre sIndicated above, <br /> 2 . EHD will notify the applicant if any EHL) 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 A � <br /> of the applicant. Future file reviews by the same applicant may require a 578 .00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates 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 /> EH oV is 01/UL00 <br /> TOTAL P . O2 <br />