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U.0 L NL-'LIVLU LHU LOU NUMULH <br /> Rgr. I,�, SAN O AN COUNTYPUBLIC HEALTH SEOCES <br /> VIRONMENTAL HEALTH DIVISION <br /> 04 EAST WEBER AVENUE,THIRD FLOOR '�' <br /> M� s �( STOCKTON CA 95202 <br /> (209) 468-3420 <br /> riUi�li ENTAL 1 <br /> .rr�x.tsa:T/CCC/\/I( PUBLIC RECORDS RELEASE APPLICATION 5 16 2000 <br /> APPLICANT �Ck� v �^^`l11�' J cuts�`n,,� BUSINESS/AGENCY iASf 500- - �L6` <br /> ADDRESS p1 1(J I V IN�'�-� S 2 3( � r 1 O� II <br /> A SS (y`t O4� 1C.Ili�l�"'2 � (� r r r r � � <br /> PHONE n�� ( 1 `'') FACSIMILE "I �S 9 4(4 - -79y9 <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEES-REQUEST PROCESSED IN 3 BUSINESS DAYS (- 0Lc�Y Cc' <br /> SIGNATURE OF APPLICANT _ Q 0✓�1� /`�- DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> C,61-z <br /> `1 S tau S( ice (-d i-�rl/�carc� Ltth ' i L <br /> (PH S4 -e>" t—v i <br /> ENVIRONMENTAL HEALTH DIVISION FILES „_...___...._._...__. _._._.._.._..__........._� <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE Fnr•.I►►rY! <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 'OL115 W TSA E VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ 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 ❑ 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 $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 /> EN 00 14 02/24/00 <br />