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12/05/01 WED 09:19 FAX 2(048 0021 RLEINFELDER reouocNu.•,eex �Illf <br /> overs raFccivso '$AN 4TSAQUIN COUNTYPUBLIC HEALTH SlIVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> i U 1 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ( 466-3420 <br /> PUBLIC RECORDS <br /> RELEASE APPLICATION <br /> APPLICANT / ^�/;�, /?J/ W—' — { <br /> Aal-d <br /> - BUSINESSIAGENCY ' `��r��'�f� <br /> ADDRESS 2g'�SE Z'iq f-le S-/" l /��,/' <br /> PHONE (.52014) qy�- �3ys FACSIMILE <br /> Oq,[-, f`/ g~067_2 � ,r <br /> TENTATIVE`APPOINTMENT DATE /21j/RZ�!/ TIME 11X-"-7a(Please give 7 to t0 business days from date of applleatlon submittal) ' <br /> uv�rs -/ 3, �/- <br /> I] CHOCK BOX TO EXPEDITE REQUEST.$97.00 FEE—REQUEST <br /> TPROCESSED IN 3 BUSINESS DAY -- <br /> SIGNATURE OF APPLICANT DATE Z-z-s-A/ <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 19300 d k /s MR ca CA Z D <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C HOUSING ABATEMENT __, S SOLID WASTE FACILITY <br /> THER CLEANUP SITE(MON-LOP) C1FOOD FACILITY - -,'❑ SOLID WASTE VEHICLE <br /> ,UNDERGROUND TANK(MON RORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUC"ARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑'POOLISPA - ❑ LAND USE APPLICATION SITES <br /> ❑ 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 file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> add indicated above <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will he 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_ Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition as released will bo 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 />