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D1 .., j l�•i�u../� f_ uw Lug uwauu< <br /> L U SAN tNVIRONMENTAL <br /> UIN COUNTYPUBLIC HEALTH*VICES <br /> HEALTH DIVISION O <br /> FEB 2 1 2001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVI IUiJNIENT HEALTFI (209) 468-3420 <br /> PE AITiSER'v'ICES✓ PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1✓f'('—+'I'GC`� / IOV66j— BUSINESS/AGENCY <br /> ADDRESS // 3J //� / Li:'�� 120 [L?2y(.c�. p �[ <br /> PHONE— C)9–7i6 Z ` (p6-Sr FACSIMILE / �J 0 �� " /�0 <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-587. FE PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 7_0=77FAT'l 37 <br /> I <br /> D rr ! i 3� a <br /> I7 L•II I <br /> ro3o I _ <br /> t 1: <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1'<UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY t7 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 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated 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 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. Future file reviews by the same applicant may require a $87.00 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 00 14 08107100 <br />