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05/08/2003 13:50 FAX _ Q002 <br /> -_n►z�RECWBD t <br /> i' ;;SAN A JUIN COUNTYPUBLIC HEALTH : 'VICES <br /> rIVIRONMENTAL HEALTH DIViSI <br /> 304 EAST WEBER AVENUE.•TH1RD FLOOR <br /> rv,Ay 0 8 NO STOCKTON CA 96202 I <br /> (209)468.3420 <br /> `PUBLIC RECORDS RELEASE APP•LIC:p►T1Q[�l <br /> ltc�.i 'tdtrit • 1 Lo Vi BusrrlEs:�ACExcY`1),t(4 g0VLR•tdlaf�l"►_ °r �. <br /> APPLICANT <br /> 3 ld'� �1,�141 <br /> ADDRESS S'G� Z6t; i�na�J• _�. _.- � --o <br /> c3 <br /> PHONE <br /> , (037' 2t�� FACSIMILE q lc.. b3� • �� <br /> TENTATIVE'APPOINTMENT DATE N�I I45l` '1 <br /> 14',z.603 TiME <br /> (Please give 7 to 10 business days from date of application submittal)OX O EXPEDITE REQUEST-$78.00 FEE—RLQ OCESSED IN 3 BUSINESS DAY. M-1/ <br /> � ?7 <br /> CHECK e 7 c-� L .�dw� 8 �a y <br /> SIGNATURE OF APPLICANT f(•{'• k�C� Q' OATS <br /> iL.E ADDRESS _� - THIS SIDE E-1D:iTAFF USE ONLY <br /> F <br /> PRUOI-tAM.-LEMENTS SEARCH <br /> 2 G � •S CAc t a <br /> Qir- o.tty nt <br /> D 1 n1ai�l I�LLwc LA(>i CA 1-•-- <br /> ------------ <br /> ENVIRONMENTAL HEALTH DIVISION FiL1ES <br /> UNDERGROUND TANK(UST)CLEANUP,'rM(LOP) ❑ HOUSING ABATEMENT C7 :iOL03 WASTE FACiLrrY <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 11 :SOLu)WASTE VEHICLE <br /> IrUNDERGROUND TANK(MONTTORINGIREMOVAL) ❑ DOG KENNEL i7 DAIRY <br /> O HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 17 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 13 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED <br /> PED FACTCING ❑ POOVSPA Ia LAND USE APPLICAT40H SiTLS <br /> O MEDICAL L WASTE FACILITY G PUBLIC WATER SYSTEM 13 OTHf:R(PL'SSE SPECIFY ABOVE) <br /> 1. <br /> List up to ten addrosses In the space above. Select the type(s)of tiles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. I�;c to.209 _¢_4rQAq or mail to ilia <br /> liddress Indicated Li1bo Ve• <br /> EHD will notify the applicant if any EHD flies exist. An appolnl:ment for rt:view will be confirmed <br /> • approximately five business days but no later than ten (10)days after receipt of applic :tion. Ti1d flies <br /> '•' wil! be held for a maximum of fn+e business days for review. Appointments should be scheduler) <br /> accordingly. <br /> -013. A file that Is actively being worked on by EHD staff may not be Imrnediataly available for review. A naw <br /> application may be submitted When the file is available. <br /> 4. Any fife not returned in the same condition as released will be reol•ganizad by EHO staff at the expense <br /> of the applicant. Future file reviews by the same applicant May require a.$78.00 depo::it prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EK <br /> A staff. .. � . <br /> 6. Applications received after 3:00 pm will ba processed the next bu!arness day+� _, :.� <br /> �_. 1 <br /> CONFIRMED APPOINTMENT DATE TIME - <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED• YES NO REVIEW DATE' <br /> EH ao 14 CZ74M <br /> TOTAL P.02 <br />