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" 9 369 4228 Dec. 05 2002 10:04RM P2 <br /> FROM NOR Env i r'onmenta 1 <br /> PHONE NO. 20 EHD%OG NUMBER <br /> DA7ERECEIVEo -,SAN JQAQUIN COUNTYPUBLIC HEALTH SECES <br /> ENVIRONMENTALHEALTH DIVISION <br /> 304£AS-r'1NiwBER AVBNII>= D F1.00R. <br /> TOCKTON CA <br /> 10 <br /> OIC 0 5 200z s <br /> (las)468•3420 - <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> r SUSINI SSIAGENCY <br /> APPLICANT i— ;c, alb I11 I.- 1 <br /> z <br /> ( Lauf <br /> ' 2 • <br /> ADDRESS <br /> 2 <br /> PHONE 3 - I~ACSIMILE X09 3 ' `�yZ nnyye� <br /> 2 D r2 TIME Vv <br /> TENTATIVE`APPOINTMENT DATE Tic R r <br /> (Please give 7 to 10 bUsInGS8 days trom date,oF app <br /> llcatiOn submittal) <br /> 4 <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00FEE— CST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> 1 tLE ADDR>r55 T>;IS SIDE FK0 STAFF USE!ONLY <br /> PFtOGRAM EUMENTS SEARCH <br /> i <br /> ENVIRONMENTAL.HEALTH DIVISION FI L S <br /> 16`l.SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING AB Y ATEMENT O SOLID WASTE VEHICLE <br /> W OTHCR CLEANUP SIZE(NON-LOP) ❑ DOG KENNEL 0 DAIRY <br /> Ir UNDERGROUND TANK(MONITORINGIRKMOVAL) O CHICKEN RANCH F] PKG TREATMENT PLANT ' <br /> W HAZARDOUS WASTE GENERATOR ❑ MOT£LIIIOTEL ❑ PUMPSR TRUCKIYARDICHEM TOILSTS <br /> O TIERED PERMITTED FACILITY ❑ POOLISPA 0 LAND USE APPUCAt1014 SITES <br /> O TATT001gooY PEIRCING ❑ PUBLIC WATER SYSTEM W OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL wASTE FACILITY , <br /> List up to ten addresses in the space above. Select the types)of files from the list alcove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 tsr mail td the <br /> dress indicated above, a confirmed <br /> ad for review will b <br /> An appointment e <br /> nt <br /> 2. EHD will notify the applicant if any EHD tiles exist. A F� <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 tieing Worked on by EHD staff may not be immediately available for rovisW. 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$89.00 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 /> � . <br /> CONFIRMED APPOINTMI=NT DATE. TIME <br /> GATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWEO YES NO REVIEW DATE <br /> - i <br />