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oat REc�v�02 14:35 2094671118 AGE STOCKTON EMD LOG NUMBER 01/01 <br /> SAN J QUIN COUNTYPUBLIC HEALTH S�,VICES <br /> ENVIRONMENTAL HEALTHDIVLOOt j ��(�� n❑ � <br /> 304 EAST WEBER AVENUE,THIRD F400RRfV�J <br /> V STOCKTON CA 95202 <br /> (209)4ea-3a2o JUL 16 2002 <br /> Eby U13LIC RECORDS RELEASE APPLICATION <br /> ��y �• I NT HEALTH <br /> APPLICANT U4a•4 BUSINESS/AGENCY �RVICES <br /> SS <br /> PHONEao9) y� � iDd6 'FACSIM <br /> !/ ILE_ <br /> Ta ;bw <br /> TENTATIVE'APPOINTMENT DATE D TIME 40•rDD <br /> (Please gl 7 to l0 uslness d from off appl tion submittal) <br /> CHECK BOX TO EXPEDITE REQUE - .00 F�; QU IN 9 B S�IINESS DAYS <br /> SIGNATURE OF APPLICANT .�IAJ� OIC l4 DATE / �S <br /> FILE ADDRESS <br /> • <br /> J <br /> T <br /> 2S 4 E .10,60 It I1 1 <br /> 4SD E - 1 D St eT C4 CA!07) <br /> '1111 19 <br /> MranthUr c <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 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(MONITORINGfREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 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 checking <br /> the appropriate box(es). At least one ilia type MUST be selected. FaX or mail to the <br /> or mail to the <br /> address Indicated above.Indlcated 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 he 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 $78.00 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 W 14 n1b1V6 <br />