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04/15/2002 14:56 <br />DATE REGk1VED <br />Vv <br />209467'' AGE STOCKTON <br />SAN J QUIN COUNTYPUBLIC HEALTH ICE <br />ENVIRONMENTAL. HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 90,402 <br />(209) 4683420 <br />114 PUBLIC RECORDS RELEASE APPLICATION <br />PAGE 01/01 <br />kHU Lull Numuk:x <br />1'' ` USINESSIAGENCY <br />A CANT <br />ADDRESS <br />PHONE _(/ 7 I�DD�t, <br />�1FACSIMILE C <br />r <br />TENTATIVE' APPOINTMENT DATE rl L TIME <br />(Plewav 1 bust ys from to of app cation submittal) <br />CHECK BOX TO EXPEDITE REQU T - S S. 0 FE — E T P 1 <br />BUSINESS DAYS <br />DA?E <br />SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑HOUSING ABATEMENT C3 SOLID WASTE FACILITY <br />❑ SOLID WASTE VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) a FOOD FACILITY p DAIRY <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL- O PKO TREATMENT PLANT <br />HAZARDOUS WASTE GENERATOR E3 CHICKEN p PUMPER TRUCK/YARD/CHEM TOILETS <br />TIERED PERMITTED FACILITY r3 MOTELIHOTEL E4 1:3 LAND USE APPLICATION SITES <br />O TATTOOIBODY PEIRCING ❑ PUBLIC LI0 OTHER (PLEASE SPECIFY ABOVE) <br />I] MEDICAL WASTE FACILITY ❑PUBWATER SYSTEM W <br />1. List up to ten addresses in th'e space above. Select the types) 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 />address indica ad above. t If any EHD flies exist. An appointment for review will be confirmed <br />2. EHD will notify the applicanreceipt of <br />approximately five business days but no later than ten (10) days should be scheduled fetes <br />will be held for a maximum of five business days for review. Appointments <br />accordingly. <br />3. A file that is actively being worked on by EHL] staff may not be immediately available for review. Anew <br />application may be submitted when the file Is available. ff at the ense <br />4, Any file not returned in the same condition as released cawiill be reorganized a $78 y E D sta t prior exp <br />review. <br />of the applicant. Future file reviews by the same applicant y require <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 />PHONE FAX INITIALS <br />DATE CONFIRMED <br />REVIEWED YES NO REVIEW DATE <br />EH oo 14 o+rouuo <br />