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r DATE RECEIVED <br /> � END�OG NUMBER <br /> w �AQUIN COUNTYPUBLIC HEALTH =RVICES , <br /> ENVIRONMENTAL HEALTH DTVI '�1 <br /> 304 EAST WEBER AVENUE,THIRD FLOG <br /> STOCKTON CA 95202 Y71 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 2E6��E4F4�_ <br /> APPLICANTVI) VAr_cA?_e - ZA BUSINESSIAGENCY <br /> ADDRESS - P,�, GC>-L 7 G5 V,rr,i o2 cA 4Sa s-3 JUN 0 4 2002 <br /> PHONE Zo9 V$1 469 FACSIMILE 209 3 c 9 270'3 ENVIRONMENT HEALTH <br /> TENTATIVE*APPOINTMENT DATE o6IlI PERMIT/SERVICES <br /> O7- TIME AWV 17H c 2cw� $A r• - IZ:oc <br /> (Please give 7 to 10 busines day from da application sub aml tttt I) <br /> CHECK BOX TO EXPEDITE REQUEST-$89 —R U 7PROCESSEDIN 3 BUSINESS DAYS FILE COPY <br /> SIGNATURE OF APPLICANT DATE 656/0-3 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> CE1vTRA L VA LLE W4-.7-e SEl2✓/cE <br /> o <br /> 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 ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/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 $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 /> •n ui Pnr --- -- - <br />