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01/28/2002 13:29 20946711 AGC', STOCKTON F'Faur_ <br /> DATE MOVED END LOG NUMBER <br /> \'I IW\% 37jOTQUIN; COU TYPUBLIC HEALTH SE ,11GES <br /> ENVIRONME1 ITAL HEALTH DIVISION <br /> 304 EAST WEB ER AVENUE,THIRD F" <5 <br /> S'Ct7 KTON CA 95202 ' s .♦, <br /> Ll <br /> 09)468-3420 / <br /> PUBLIC RECORD RELEASE APPLICATION <br /> APPLICANT <br /> \V;F� \., _ BUSIN SS/AGENCY Q e' <br /> ADDRESS /� Q <br /> PHO UIA t7 (J� FACS1 ILE <br /> ' . ENTATIVE*APPOINTMENT DATE TIME o 1 <br /> (Please give 7 to io business days from date of application submittal) w <br /> CHECK BOX TO EXPEDITE REQUEST-$7 0 FEE—REQ EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE L Z S OZ <br /> Fl ADDRESS <br /> - <br /> 0-7 Ov 0 <br /> Ok <br /> ML <br /> gh <br /> ENVIRONMENT L HEALTH DIVISION FILES JAN 31 2002 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORWGIREMOVAL) ❑ DO KENNEL ❑ DAIRY <br /> HAZARDOUS WASTe GENERATOR ❑ CHI KEN RANCH © PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MO L/HOTEL CJ PUMPER TRUCKIYARD/CHEM TOILETS <br /> Q TATTOOIBODY PEIRCING ❑ P L/SPA - © LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑ PU LIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space abo e. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file ype MUST be selected. Fax to (200.464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five business days but no ater than ten(10)days after receipt of application. The files <br /> will be held.for a maximum of five busine s days for review. Appointments should be scheduled <br /> accordingly. i <br /> 3. A file that is,actively being-worked on by HD staff may not be immediately available for review. A new <br /> application may be submitted when the fi o is available. <br /> 4. Any file not returned in the same conditio i as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a $78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be onflrmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> CONFIRMED*APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 0110=0 <br />