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u yi L�yi L��:i 11:05 FAX la 002/00; <br /> Roa EC 11`U/l �D,' SAr ENVIRONMENTAL HEALTH DIVI"+ON VICES <br /> �"� I 304 EAST WEBER AVENUE,.THIRD FLOOR <br /> AUG 2 8 2003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> } <br /> �_FNVRQNMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERPAI ! <br /> !�" <br /> APPLICANT J /! 1 BUSINESS/AGENCY <br /> ADDRESS <br /> 1(pq &M A CQIII11t1 ve S n VIQQ r QVQ 1 <br /> PHONE 11 5 — -1�� FACSIMILE &116 —V 32 - �3 5 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of'application submittal) <br /> CHECK BOX TO EXPEDITE REQUES $78.00 FEE.-R ?T PROCESSED IN 3 BUSINESS DAYS UP <br /> • <br /> ZJ� <br /> SIGNATURE OF APPLICANT DATE %/,2'9/03 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Main, a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ THER CLEANUP SITE(NON-LOP) C3FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> 11NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH D PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCWYARDICHEM TOILET <br /> ❑ TATTOOMODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> O 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 check <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to t- <br /> address indicates!above. <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 fil <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 N <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 expe <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to rev v. <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 /> I CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED. YES NO REVIEW DATE <br /> EM 00 14 0=4100 <br /> TOTFL P.02 <br />