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08APR.23.20043: 9:15AN54�IAPEx_ ENVIROTECH,INC. NO.588 P.2' -- i <br /> ��!]nfF Ht�LNtiL• <br /> 11010 OG Nuw" <br /> AN .,�,.,QUIN COUNTYPUBLIC HEALTH „_�tVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 2 3 2004 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> STOCKTON CA 95202 <br /> (299)4683420 <br /> 7 <br /> c - 0UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT J2rt+�( r� o r-5( y <br /> �j HUstNt`SSlAGENCY <br /> ADDRESS It2� L( t' r( e-c uj C.A 96&-70 P <br /> I — assPNONE Ctl(0 <br /> TENTATIVE*-APP INTMENT 'ATE TIME <br /> (Pleaz�0 Ve 7 to 10 business days from date or application submillal) <br /> 85,00 • `' <br /> CHECK 80X TO EXPEDITE QU 00 FEE REQUEST PROCESSED IN 3 UUSINE55 DAYS l — � <br /> SIGNATURE OF APPLICAN DATE <br /> FI ADDRESS THIS SIDE PHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 455 r: II+k <br /> o � � <br /> D <br /> -603ri0h f+ I CALts \ <br /> 00 C a`. OA -T <br /> 5 I t r <br /> 5 1 5f r-A usT <br /> 2, Ir I 114, 5-�- 7S77 <br /> T <br /> Qy <br /> ENVIRONMENTAL HEALTH QMSION FILES ;,i <br /> 16 UNUERGROuNO TANK(UST) I EANUP SITE(IOP) Cl HOUSING ABATEMENT <br /> O SOLID WASTE FACILITY <br /> Cl OTHER CLEANUP SITE(NON OP) 13 FOOD FACILITY G SOLID WASTE VEHICLE <br /> ❑ uND6RGROVNO TANK(MON ORINGIREMOVAL) 0 DOG KENNEL O DAIRY . <br /> .ZHAZARDOUS WASTE GENE OR d CHICKEN RANCH o PU TRI= RUCK AP.DiPLANT <br /> O TIERED PERMTrYED FACILITY G MOTEIJHOTEL C) PUMPERS ApPLjYARDICNEM TOI�.Ei <br /> 0 TATTOOISODY PEIRCING 0 POOLISP/1 Q LANA USE AtaP(IGA7]ON SfTES <br /> ra MEDICAL WASTE FACILITY , ❑ PUBLIC WATER sYSTEM ❑ OTHER(pLEASP-_SPCCIFY At30VE) <br /> 1. List up to ten add>esses in the space above. Select the typo(s) of files from tho list above by check <br /> the appropriate a x(es), At least one fila type MUST be selected. 'Fax to 209 464'•0138 or mall to tl <br /> address 'ndic`ate ab'eve. <br /> 2, EHD will notify th applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately fiv business days but no tater than ten (10) days after receipt of application. The fil <br /> will be held far a aximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that,is actio Iy being worked on by EHD staff may riot be immediately available for roview. A w <br /> application may b subml"ed when the fila Is available. <br /> 4. Any file not retu'roed in the Same condition as released will be revrgaltizod by EHD staff at the expf e <br /> of the applicant. lfuture file reviews by the same applicant may require a $89.00 deposit prior to M W. <br /> 5. 'TENTATIVI=appointment dates must be confirmed with EHD staff. <br /> 6. Applicati 'nS received after 3:00 pm will be processed the next business <br /> CONFIRMED AP110INTM NT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES ' NO pEVIE:W DATE -- _- <br />