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�'� I_ I J LHU LUU NUMUU1 <br /> U11 ' - SANAQUIN COUNTYPUBLIC HEALT�.RVICENVIRONMENTAL HEALTH DIVISION <br /> FEB 1 4 2001 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 f <br /> EN'�IIE�UI�(G'.t iti i� rERLTH (209) 468-3420 <br /> PEh��IiTr;E �,%ICES PUBLIC RECORDS RELEASE APPLICATI-ON <br /> APPLICANT STT k 8v--� n <br /> aZ u, BUSINESS/AGENCY S 6-\-P N �I I ItS IT12 I <br /> n <br /> ADDRESS �, t� (3 I UD c�C1 D Z.K-�010 j4 �ry 3'e,r� <br /> PHONE (O�OR) f 3a•' d�J ) (� FACSIMILE UZ 17 q 6r? -'� <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUE T-$87.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ZI u 61 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> z45 I St <br /> ae <br /> t4- <br /> _n <br /> Q <br /> r <br /> estz Cie ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 to (209) 464-0138 or mail to the <br /> address indicated 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 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 EHD 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. 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 after 3:00 pm will be 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 08/07/00 <br />