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SAN �QtliN,CLA-1V`r'YFL1tit_ICrIEALfiS "`.FHVi�.tS <br /> `.ENVIROWENTAL HEALTH DWIS�.A <br /> MAR 13 2001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 L� <br /> (209)468-3420 CCCIIT�� I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> Af A e-ems SUSINESSIAGENCY <br /> M"3 S fktd aC,�f� /S <br /> ao9 �'/arl-/D06 FACSIMILE AW9 9k 7- <br /> TENTATIVE-APPOINTMENT OAT S .r(Aa,A TIMEO�•OO A--\�r _- <br /> (Phase give T to JD busin days Wool(late of aPPIIWtioa submittal) <br /> (01 CHECK BOX TO EXPEDITE REQUESTREWXYEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT \ ` z DATE 3 1 Z d f <br /> FILE ADDRESS <br /> I <br /> t V•- <br /> F - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(USI)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NOH-i.OP) ❑ FOOD FACILITY ❑ SOLID WASTE V"ICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTF.tlHOTEL Q PUMPER TRUCKJYARUXHEM TOILETS <br /> t7 TATTOOIBODY PEIRCING ❑ POOIJ5PA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLVASE SPECIFY ABOVE) <br /> 7. 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 (2091464-0138 or mail to the <br /> address indicated above. <br /> 2- EHD will notify the appucant if any EHD files exist. An appointmentfor review will be confirmed <br /> approximately five business days but no later than ten(90) days after receipt of appifcation. 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. Futur®file reviews by the same applicant may require a $T8.DO 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 na 14 *I G -��-W <br />