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FKUPI : NOA Environmental PHONE NO. : 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> UAI k RECEIVED, <br /> ,i eHe N <br /> o SoUMBER <br /> N �bAQUiN COUNTYPU13LIC HEALTH'S'ERViCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DEC 0 3 2002 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> s:.NV;1 R 0W EIVI_ H ALTH (209)468.3420 <br /> FF�;nQITriSFRV1cFVBL1C RECORDS RELEASE APPLICATION <br /> APPLICANT typy F—ACGO, BUSINESS/AGENCY r4bk :ENVi P0n11ME0rt'AL_ <br /> ADDRESS/ 7- *DV S�rJ L01>1 \\ �,p <br /> PHONE (0l) NF1--TLF ZO FACSIMILE (7-M) 34 f 47'24 <br /> TENTATIVE"•APPOINTMENT DATE Imo"` 1 "'D 2r TiME ! OW 4 <br /> (Please give 7 to 10 business days from data of application submittal -0;6 Jar) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3LIZZI AYS �/ Q <br /> SIGNATURE OF APPLICANT DATE [Z-3-102. - <br /> FILE ADDRESS ' tttiz.r o THIS SIDE EHD STAFF USE ONLY <br /> �^ PROGRAM ELEMENTS SEARCH <br /> 1 2q iJ.Gvi �}vc. f'4-VF N. 6-vi IA . .. <br /> w u'N <br /> V'/ 1226 c 1 <br /> 8 iC t ) <br /> 00 <br /> ✓ 2( E. 'C4• <br /> ENVIRONMENTAL HEALTH DIVISION FILES \4A <br /> Nt,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 1A OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLiD WASTE VEHICLE <br /> IS UNDERGROUND TANK(MONITORING/RFMOVAL) ❑ DOG KENNEL. ❑ DAIRY <br /> HAXARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERmr TED FACILITY 0 MOTEL/HOTEL Q PUMPER TRUCK/YARD/CHEM TOILETS <br /> 173TATTOO/BODY PCIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION Si MS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 19 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 filo is available. <br /> 4. Any fits 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 1 <br /> DATE CONFIRMED .-PHONE FAX •INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> .AAI If1f '•••• <br />