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10-04-2000 09;41Ari FRCm To .02 <br /> S N JuQUIN COUNTYPUBLIC HEALTH SERVICES LHU`UC.NUMUCR <br /> hNVIRONMENTAL HEALTH DIVISION t <br /> 04 EAST WEBER AVENUE,THIRD FLOOR <br /> t� STOCKTON CA 95202 <br /> (209) 468-3420 <br /> I <br /> P BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT'nOY) �r BUSINESS/AGENCY CCOfN0C�Y1- ��-�T (-� '� }}NOLO_GIES� I;"JC.. <br /> ADDRESS <br /> I �1 <br /> PHONE I FACSIMILE � 23� O.j:; 35 <br /> T ENTA T i V E"APPCVIN MENT ATE I 12- OO TIME t/ <br /> ( leaso 6ivc 7 to 10 buslness days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQ EST-587-00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT DATE 10 /,� f OD <br /> I <br /> I <br /> FILE A DRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 485 W. r _ <br /> 1zg6 _ ei- — <br /> I t-►� i <br /> W, 0*Vn s tri CA <br /> Uj CA <br /> 3a'1 - C) l Iv <br /> t � <br /> ENVIRONMENTAL HEALTH DIVISION FILES L'+ 2-1 <br /> r <br /> NDERGROUND TANK(UST)CLEA UP SITE(LOP) ❑ HOUSING ABATEMENT OLID WASTE FACILITY <br /> ,p. OTHER CLEANUP SITE(NON-LOP) I ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORI /REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> C7 TATTOCIBODY PEIRCING I ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> 1 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten address Sin 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 abo e. 1 <br /> 2. EHD will notify the app icant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bus ne s days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maxi ulr of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively b ing worked on by EHD staff may not be immediately available for review. A new <br /> application may be sub itted when the file Is available. <br /> 4. Any file not returned in thelSam e condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Futur fit¢ reviews by the same applicant may require a $97.00 deposit prior to review. <br /> 5. 'TENTATIVE appointm nt dates must be confirmed with EHD staff. <br /> 6. Applications received a tec�3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT ATS TIME <br /> 1 ATE CONFIRMED I PHONE FAX INITIALS <br /> REVIEWED YES i NO REVIEW DATE <br /> E7 00 is 06107100 <br /> TOTAL P.02 <br />