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RPR 01 2003 3: 35PM SC, 1 510 .B25 817133 p. 2 <br /> e E NTA A PAGE 01 <br /> 04/01/2003 15:27 4640138 �+ �3M.Ea <br /> DATE R`` F VED ru,�ecov- �r r <br /> ! /0 <br /> n]I���I ;I \`�J�rJ N JOENVIRONMENTAL HEALTH D VIS10 V <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> APR 0 1 2003 STOCKTON CA 95202 <br /> (209)468.3420 <br /> ENVIhUNMEN I NEALTUBLIC RECORDS RELEASE APPLICATION — J <br /> BrUSINES/S�IAGE�NCY <br /> APPLICANF /JAA <br /> ADDRESS <br /> HONE / ` G '' ` C` FACSIMILE <br /> IT <br /> ��jjEaa 9 r-; c+Y � TIME <br /> �ATIVE" APP INTME DATE IME <br /> Iw Tsubmittal) y <br /> (Pfaas ve 7 to 10 ualness d.y P s from dale of■ p <br /> ❑ CHECK BOX TO EXPEDITE RECUEjfi-$qg o,FEE R CUE f PR ESSED IN 3 BUSINESS DAYS , <br /> DATE <br /> SIGNATURE OF APPLICANT `� `'� <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> t-Y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,..,,<�SOLID VIASTE FAC:LIT`/ <br /> NDERGROUND TANK(UST) b FOOD FACILITY T)CLEANUP SITE(LOP) C3 HOODING ABATEMENT O SOLID WASTE VE,-FCLE <br /> p DAIRY <br /> OTHER CLEANUP SITE,(NON-LOP) ) ❑ DOG KENNEL 0 PAG TRrATMENT Pl.4NT <br /> O UNDERGROUND TANK(MONITORINGIREMOYAL 0 CI{ICKEN RANCH {] PUMPER TRUCKPIARDICHEM TOILETS <br /> D HAZARDOUSWASTEGENERATOR p 11AOtEUHOTLL LAND USE APPLICAVON SITES <br /> O TIERED PERMITTED FACILITY O POOUSPA <br /> - TATTOOIBODY PEIRCING ❑ �� D OTHER{PLEASfi 3-E.CIFY ABOVE) <br /> O MEDICAL WASTE FACILITY - ect the types)of tiles from the list above by n9 <br /> checKl <br /> 1. List up to ten addresses in the space above. Sel <br /> M riaie box(es). At feast one fil9 type MUST be selected. Fax to (2')9}464.1113$ or mail <br /> the appro p <br /> address I drt icated above- y p ointment for review wll)be contfrmed <br /> 2. EHD will notify the applicant If an EHD fifes exist. An a10P da s after receipt of application. The files <br /> approximately five business days but no later than ten ( ) Y <br /> will be held for a maximum 01 five business days for review. Appointment; should he scheduled <br /> accordingly. not be Immediatel)I avallabl"for review. Anew <br /> 3. A file that is actively being worked on by END staff maY <br /> application may be submitted when the file is available. prior a review. <br /> q Any file not returned in the same condition as releasedant may requlrell biZa 539.00 posit P the expense <br /> of the*TENTATIVE <br /> ant. Future o'intmantle ravlOws,by dates must be confirmed onflrm d with EHD staff. <br /> g 'TENTATNE aFP m will be processed the next business day. <br /> 6 <br /> Applications received after 3:00 Q <br /> TIME —_----_--- ------- <br /> CQI�FIRMED APPOINTMENT SATE )N)TIAL:i <br /> PHONE FAX <br /> OATS CONFIRMED _ <br /> YES NO REVIEW DATE <br /> REVIEWED �J(�l <br />