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FRON : NOA Environmental PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PN P2 <br />A <br />SAN .AQUIN COUNTYPUBLIC EHOI,DCNU1l9Efi <br />t� r r-, _ WEALTH SERVICES <br />�; t , j`l, /' ff— - ENVIRONMENTAL HEALTH DIVISION <br />Lr,t0%304 EAST WEBER AVENUE, THIRD FLOOR <br />OCC 2 3 STOCKTON CA 95202 <br />2002 (209) 468-3420 10901 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT <br />BUSINESS/AGENCY A/MC►IV�ront! <br />ADDRESS Al. <br />PHONE4--O .36%-37C)( _FACSIMILEk)-�ZZg <br />TENTATIVE' APPOINTMENT DATE 2603TIMEOD `.a�"�j jG 7 <br />(Pleaso give 7 to 10 business days from date of applicatlon submittal) w _�f <br />i <br />CHECK BOX TO EXPEDITE REQUEST - 589.00 FEE- RE�ST�OCESSED fN 3 BUSINESS DAY L4 <br />1- DATE � z �Z-- <br />SIGNATURE OF APPLICANT <br />...THIS <br />SIDE EHD STAFF USE ONCY-- <br />PROGRAM ELEMENTS SEARCH <br />. ,. �• • . <br />��� � <br />A 9 F1 XYM WAVEr <br />rte_ <br />f. <br />rdL���i�rriin�■■���r <br />Wjj J - <br />ENVIRONMENTAL HEALTH DIVISION FILES 1� <br />W UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLJD WASTE FACILITY <br />W OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />;U UNDERGROUND TANK (MONITORINCtREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMI•NY PLANT <br />Cl TIERED PERMITTED FACILITY O MOTEUHOTI;L ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />CI TATTOWHODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPUCATION Sn'J'S <br />Cl MEDICAL WASTE FACILITY ❑ PU13UC WATER SYSTEM M OTHER (PLEASE SPECIFY ADOV> }- <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. rax 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 retumed 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 />G. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE. <br />OATE CONFIRMED <br />REVIEWED YES NO <br />TIME <br />PHONE FAX INITIALS <br />REVIEW DATE <br />