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\, U3/U9/Lu04 16:41 FA-1 LU9 U48OU21 IQIUU2 <br /> V Fho L.OG NUMBER <br /> 4)A�7�7�V E 0 SAN JOENHSERVICES <br /> ENVIRONMENTAL ALHEALTH DIVISION <br /> MAR 1 0 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> tNVIRUNMENT HEALTH PUBL (209) 468-3420IC RECORDS RELEASE APPLICATION <br /> APPLICANT /"u���� Md`r�r/G� t3USINESSIAGENCY_ �"�°�''+ ����� <br /> ADDRESS <br /> PHONE 9��'� 3��S FACSIMILE — O 6 <br /> / <br /> TENTATIVE`APPOINTMENT DATE _ J/ �S/,-Z-Y, -TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE—REQUEST PROCESSED IN 0 BUSINESS DAYS 001, <br /> 51GNATURE OF APPLICANT DATE 3A? GGA <br /> FILE ADDRESS THIS SIDE EHD 5TAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Sl eI� 76�d A <br /> WI oV a,,Z �+ 5-F�l.�+o n c �l <br /> 5244 A, q-Trte, <br /> 5261 /V 14 (,f-^'79q c Rom c s+ k <br /> C?2, A.) 14 [L:LL94- �r z tie s <br /> 9? ca, Paz i <br /> X140( IU A(VI-j 1.7 Fro- d <br /> 5(Zo H 61 P,%-- Fo <br /> 8 Imicn R0a4 S 4dc4L k_1 <br /> 515- N.p ten M Ra-4- S.,f ct<*% <br /> 5030 I4­1�—n A—J- Sexy ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT � UD WASTE FACILITY <br /> L] FOOD FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) <br /> SO <br /> WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL DAIRY <br /> DOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTEUFiOTEL C PUMPER TRUCKIYARD/CH5dTOILETS <br /> 0 TATTOO/BODY PEIRCING <br /> ❑ POOLISP411ND USE APPLICATION SITES <br /> E3MEDICAL WASTE FACILITY '112fPUBUC WATER SYSTEM 0 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 38 or ail to the <br /> address Indicated bove. • <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 ne, <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 expens <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to revie! <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 >pAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />