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05/09/2002 15:11 2094E" 1.8 AGE STOCKTON PAGE 01/01 <br /> UAIt:Nectrveu EHP L00 NUMBER <br /> SAN .,vAQUIN COUNTYPUBLIC HEALTh oERVO <br /> IRONMENTAL HEALTH DIVISION <br /> p'I <br /> f­41EAST WEBER AVENUE THIRD FLOOR 11C) <br /> STOCKTON CA 95202 f' r1 i <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT U BUSINESS/AGENCY Q� �• <br /> ADDRESS ry �07h <br /> PHONE ao q) yd <br /> FACSIMILE ' <br /> TENTATIVE'APPOINTMENT DATE A at�lmgs <br /> nn MEt(Please give 7 01om d of appll tion submittal). <br /> CHECK BOX TO EXPEDITE REQUE -$78.00 FEE-REQUEST PROC IN 3 SINES$DAYS <br /> ///SIGNATURE OF APPLICANT DATE <br /> FII-F;ADDRESS <br /> it D a Ck�rl s� s <br /> d y 5a L <br /> IZ) <br /> d r' 7"d C9"n <br /> 01A 9 <br /> 131-3 25- r- r a <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(MONITOR]NGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOUSPA In LAND USE APPLICATION SITES <br /> CI 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 (2091464-0138 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$78.00 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 DUOS= <br />