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OCT 16 '02 0935 FR..PR TIAL TO 464Q1�R P.02/02 <br /> .......ar ...... . �1aCalalnp <br /> SAN:r AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> 46543470 ) rr <br /> C,.P'U�Br�LIC RECORDS RELEASE APP{L.I�CATION �n}I�,���r��III`�LI�=j.L�) <br /> MPIiCANrI G2^y�IfN .�,.^�t'/ttl rVy'L PEg ♦DUCSWESYA66lGT . �{� 6' ZOOZ <br /> ADDRtS5�3�oz MrrA�W. t,41ay- b�_ <br /> Pnora:_ 4 -ap -orto- � IFAdflIQ E ENVIRONMENT HEALTH <br /> T>NTATP&-AvvoerTiniNITDATE E ��{LZNfIiISERVICES <br /> �Iaa.e1•.7m ryggiMrflb,a,e, wemuWB <br /> WX . <br /> CHECK TO EXPEDITE REC P7 DAY <br /> SIGNATURE OF APPLICANT A DATE 1 OLljb U2- <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> JAI 2HAPIF <br /> Cr <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O UNORGROUNO TANK(UST)CLEANUP SITE(LOP) O NOOSING ABATEMENT 0 SOLID WASTE FArAnY <br /> O OTHER CLEANUP SITE(NONIOPI O FOOD FACniry O SOLID WASTE VEHICLE <br /> O UNDERGROUND TANK(t40Nr(ORRIGnMOVA4 O DOC KENNEL - O DART <br /> 0 HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PRO TREATMENT PLANT _ <br /> 0 TIERED PEIOURED FACnITY O MDWLATOTEL O PONPERW{UCiOrANO1C11EM TOILETS <br /> O TATTOOBOOYPERQNG �pOOLRPA O L AND USE APPl1GTiON SifES <br /> O MEDICAL WASTE 1U <br /> fACTf O PUBLIC WATER SYSTEM O OTHER Pile �-6 <br /> List up to ten addresses)n the space above. Select the type(*)of filesDatthe appropriate box("). At least one file type MUST be selected 209 464-0 th <br /> address IndNated above, <br /> 2. END will notify the applicant if any ERD files exist An appointment for review acon ed <br /> apprOXirbatey five business days but no later than len(10)days after receipt of application. The}Iles <br /> will Wheld for a maximum of Ov0 DUSinesa days for review. Appointments should be scheduled <br /> ' <br /> accordingly- <br /> 3. A fila that Is actively being worked on by EHO staff may not be immediately available for review. A now <br /> application may be submitted when the file Is available. <br /> 4, Any Ole not returned In the same condition as released will be reorganized by EHO staff at the expense <br /> Of the appileant. Future Ile reviews by the some applicant may require a$89,00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with MD 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 /> REV EWE0 YE � "J1,0.... _..__fiEtOEld.nwT•c _ w.v <br /> .. <br /> Post4r Fax Note 7671 D71e a <br /> m Poem <br /> rAMfi <br /> )MAW 10M. <br /> Iwwa, fembb <br /> FOP l7 v <br /> 0 fele <br /> a <br /> OCT 15 '02 10120 4640130 PAM.01 <br />