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DATE RECEIVED EHD I,OG NUMBER <br /> w SAAQUIN COUNTYPUBLIC HEAL SERVICES, <br /> u E 'NVIRONMENTAL HEALTH DRXRON ' <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 6"i/"�n"lo Cin is Z BUSINESS/AGENCY �nOrnA <br /> ADDRESS U /30 o200 7 fov.-0m.4 04- 91ur V)'-& awn <br /> PHONE 707 - V jF--iz z 7 FACSIMILE X07 -9'3 O y <br /> IVE*APPOINTMENT DATE TIME <br /> �^{EC TIn (Please?ge 7 to 10 business aysfro dateof plirINESSDAYS <br /> submittal)ttUl uuuA FTHRCq@o� TO EXPEDITE REQUEST9.00 FEE QUE ASIA pERM •-� <br /> ENVIAUiVNItEWRT�:Pff6PPLICANT DATE <br /> P <br /> FILE ADDRESS THIS SIDE EHD STAFF USE- Y <br /> PROGRAM ELEMENTS SEARCH <br /> 1 <br /> L-/4 �?v'?30 6 <br /> OGc»t.Q/�• '; (,J/.0� /Ai'� /ill A=�' . <br /> ENVIRONMENTAL HEALTH DIVISION�� FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ USING ABATEMENT OLID WASTE FACILITY �} <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ®' FOOD FACILITY ❑ SOLID WASTE VEHICLE?, <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ G KENNEL 13 DAIRY ", <br /> ❑ HAZARDOUS WASTE GENERATOR � CHICKEN RANCH E3PKG TREATMENT PLAT y <br /> ❑ TIERED PERMITTED FACILITY ElMOTEL/HOTEL � <br /> HOTEL OUMPER TRUCK/YARDitAEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ OOL/SPA C�(�ND USE AP PLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 4A PUBLIC WATER SYSTEM gra1K'OTHER(PLEASE SPECOY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboYe,by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 AJE mail to the <br /> address indicated above. <br /> �. t <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be con�irmed <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 sdheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available foi'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 />