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07/08/2002 MON 12;50 FAX 916 5654356 <br />uri un. tun[ au:ye 4b ENVIR0",fNTAI WTH <br />ONJOAQUIN COUNTYPU13LIC HEALTH SERVICES <br />II ENVIRONMENTAL HEALTH DIVISION <br />LOOk <br />304 EAST WEBER AVENUE, THIRD FLOOR � <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />,'Ili 'Ili <br />V <br />8001/001 <br />PAGE 01 <br />.. �tOC Hl1A18ER <br />APPLICANT r' <br />t\ <br />A / - -J 13USINESSIAGENCY c.% r✓t/!/ln. l.�.s-.�...v <br />dRess +���-��� <br />9 <br />PHONE n _ 1�Q �r $� <br />C�--•'+� FACSIMILE/G' 5 <br />a TENTATIVE' APPOINTMENT DATE <br />O s s TMC(PIC=* give Tt7 d <br />apprl submittal) I <br />1� <br />CHECK DOx TO EXPEDITE REQUEST- ,00 F Qu ST OCESRIC411NESS PAYS <br />SIGNNI,'URE OF APPLICANT DATE �A�L <br />c. <br />THIS SIOE� CHO STAFF USE ONLY <br />WIG <br />.,�=W(gra 01111111 <br />=119111MIMIMINOR <br />2rL 1/ ✓/ �. M3 . f' L. l/ I�111_II�I� <br />10 <br />N <br />0.1 <br />9 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />IIS UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />D HOUSING ABATEMENT <br />❑ SOLID WASTE FA'r1L rTY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />D FOOD FACMM <br />❑ SOL" WASTE VEHICLE <br />❑ UNDERGROUND TANK (MONITORING(REMOVAL) <br />D DOC KENNEL <br />❑ DAIRY <br />iR HAZARDOUS WASTE GENERATOR <br />0 TIERED PERMITTED FACILITY <br />D CHICKEN RANCH <br />Cl PKG TREATMENT PLANT _ <br />❑ TATTOODODY PEIRCING <br />❑ MOTELIHOTEL <br />D POOUSPA <br />D PUMPERTRUCKIYARO/CHEMTOIL-M <br />CI LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILoFY <br />D PUBLIC WATER SYSTEM <br />o OTHER (PLEASE SPECIFY ABOVE) <br />1, List up to tan 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 mall to the <br />address indicated above, <br />Z• E.HD 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 fifes <br />will be held for a maximum of five businass 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 $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. <br />TIME <br />DATE CONFIRMED PHONE FAX <br />REVIEWED_ YES NO REVim"jn Ik 1 .. <br />Post-h'Fax Note 7671 D.E7 !L Mwp b - <br />To I From <br />A <br />COWL ° �C.o 157 r <br />enmeN Ham .I�w! G ' <br />�./- Zf) <br />JJ 7.'G/n r� 1 Z0 rl r+'/Ua1 <br />INITIALS <br />