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_______27/30/2002 13:48 20946711 AGE STOCKTON PAGE 02/02 <br />. <br />+ JOAQUIN <br />HEALTH <br />■ <br />ONIVIENTAL HEALTH DIVISION <br />ti4. EAST WEBER AVENUE, THIRDy-95202 <br />e: <br />STOCKTON CA <br />a <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION NEW <br />a <br />UN <br />W <br />T1�',I'!�1i1[al�ir'�1T/.�'�lti�I'/ • ' ��►�I�LI/'.��.a��•��..• <br />ADDRESS <br />PHONE <br />TENTATIVE" APPOINTMENT DATE <br />(Please give T <br />�( CHECK BOX TO EXPEDITE Rt; <br />SIGNATURE OF APPLICANT <br />it /t <br />f3 i <br />It <br />TIME <br />r• <br />date of ap icatlon submittal) <br />/ j <br />f, DATE V3 <br />E <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SiTE (NON -LOP) 13 FOOD FACILITY ❑ SOLiD WASTE VEHICLE <br />UNDERGROUND TANK (MONiTORINGIREMOVAL) 0 DOG KENNEL O DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br />TiERED PERMnTED FACILITY ❑ MOTEUROTEL 0 PUMPER TRUCi/YARDICHEM•TOILETS <br />❑ TATTOO/BODY PEIRCiNG ❑ POOL/SPA C7 LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY® PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br />1. I_ist up to tan 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 '200 464.0130 Qr mail tot <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />than ten (10) days after receipt of application. The files <br />approximately five business days but no later <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 E O staff may not be immediately available for review. A 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. Futuro file reviews by the same applicant may require a $78.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must bee-conffrmed 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 <br />REVIEWED YIES NO <br />INITIALS <br />.« <br />