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' EHD LOC RUM3M <br /> E RECGIYE I I,- <br /> '���—� SANJJt�F IN COUNTYPUBLIC HEAL: SER Es <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR2 20 0 304 EAST WEBER AVENUE.THIRD FLOOR <br /> STMKTON CA 95202 <br /> ENViF;uN�u`E -H <br /> (209)X468-3420' <br /> �i;-C' �:PUBLIG RECORDS RELEASE APPLICATION <br /> APPLICANT �^-d' Grp Z BUSiNESWAGENCY <br /> ADDRESS <br /> C�4 4?a�.G]' :;7 <br /> PHONE(2;D`) Wa f3�',5- FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE^_ `�/' � TIME *ace2001 <br /> (Please give 7 to III business days from date of application subn9ttal) I <br /> CHECK I&OX TO EXPEDITE REQUEST-$87,01)FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EMD STAFF USE ONLY <br /> PROGRAM ELEWNTS SEARCH <br /> NFF 3 7 d iF- 14,w.r,-,O"Cr, <br /> q9 <br /> 10f 3747 -7 Al - 441 <br /> 1 <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT les,OLJD WASTE FACILITY <br /> 0-07MFR CLEANUP SITE(NON-LUPI a FOOD FACILITY Z,30UD WASTE VEHICLE <br /> -0-UNDERGROUND TANK(moNITORiNGfP:MOVAL) ❑ DOG KENNEL �rK!G <br /> -Y <br /> ,.H'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RARCN TREATMENT PLANT <br /> d TIERED PEIiiYItTTED FACILITY ❑ 14tOTlLIHOTEL <br /> MPER TRUCKlYARDICHEM TOILETS <br /> 15 TATTOCIBODY PEIRCING ❑ POOtJSPA P LAND USE APPLICATION SITES <br /> . MEDICAL WASTE FACILITY 8 W%1! $ t-. ❑ 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 o d209�464-0138 ar mail to the <br /> address indigajed 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 heist 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 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 atter 3:00 pm will be processed the next business day. <br /> LDATE <br /> MED APPOINTMENT HATE TIME - - <br /> NFIRMED PHONEFAX INITIALS <br /> D YES NO REVIEW DATE" <br /> EM m 14 95MMC <br />