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DATE RECEWED <br /> 400 SAN •IOAQUIN COUNTYPUBLIC HEALTH RERVICES EHD t,OG NUMBER <br /> ENVIRONMENTAL HEALTH DTVI,*N <br /> kej 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 t <br /> (209)468-3420 T7 <br /> PUBLIC RECORDS RELEASE APPLICATION ' <br /> Fn <br /> APPLICANT`bAj� Vl4CC.n�CZ-ZA BUSINESS/AGENCY <br /> ADDRESS - P.O.f. 13p>C 2 G Vl c t-ca2 C-A . q-529--3 JUN 0 4 2002 <br /> PHONE_ 209 MMZ 41$/ 969 'A FACSIMILE 209 3 r=.9 2-703 ENVIRONMENT HEALTH <br /> I� ` <br /> PERMIT/SERVICESTENTATIVE*APPOINTMENT DATE ©6 02 TIME Am\/ '1'FtAr - �Ztoo <br /> (Please give 7 to 10 busines day from da application submittal) <br /> u r <br /> CHECK BOX TO EXPEDITE REQUEST-$89 -R U rPROCJESWSED IN 3 BUSINESS DAY <br /> FILE C P <br /> SIGNATURE OF APPLICANT DATE 6s o T <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Ce <br /> L" /33 E. T <br /> L06 CA . Qsa y p <br /> 5 6O <br /> ENVIRONMENTAL HEALTH DIVISION FILES C 144 Jltj} <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY ~ <br /> 11 OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY ❑ SOLID WASTE VEHICLE 6/1 V, <br /> ❑ UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ 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 ❑ POOLISPA ❑ 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 $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 /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />