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=ROM NOA Environmentd'1 PHONE NO. : 209 369 4228 ag. 08 2003 03:011`11 P2 <br /> - •• � •�• ISI I I yti. r Iy�v � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 8 2003V 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 O <br /> (209) 468-3420 <br /> ;t <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT L !!- 07.�� e BUSINESSIAGENCY_A jn , -„V: - <br /> ADDRESS / ` <br /> PHONE S 3�-7 / FACSIMILE(-09 30 17-2 <br /> TENTATIVE'APPOINTMENT DATE <br /> g/Zo /o TIME <br /> (Please glvo 7 to l0 buslnos ays from date of npp11cation submlttat) <br /> • <br /> CHECK f30X TO EXPEDITE REQUESyT- 9.QQFEE_ QUEST PROCESSED IN 1 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L•��— DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL. HEALTH DIVISION FILES <br /> 2�r UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT I!r SOUR ftstE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) M FOOD FACIUTY 0.SOuu WASTE VEHICLE <br /> 2Y UNDERGROUND TANK(MONtTOR1NG/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> -O'HAZARDOUS WASTE GENERATOR M CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY 0 MO`EUHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/nODY PEIRCING Q POOLISPA ❑ LAND USE APPUCATION 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 bo selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any END 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 riot be immudiately 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 bo confirmed with EHD staff. <br /> G. Applications received after 3:00 pen will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> CATE CONFIRMED PHONE FAX INITIALS <br /> ?EVIEWI_D YES NO REVIEW DATF <br />