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DATERECEIVED m <br /> \v 1W SANMAQUIN COUNTYPUBLIC HEALT&PERVICES , EHD I,OG NUMBER <br /> NVIRONMENTAL HEALTH DIV . .ON <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> q9 <br /> STOCKTON 95202 <br /> (209) 468-3-3 420 <br /> \ I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT�f'fry� yG\A 4\� BUSINESS/AGENCY ���- <br /> ADDRESS �I.��- l�� ���� 3 Mt 'I'a °C S'3S/ PERMIUSEBVI FS <br /> PHONE 2.09 S�{-�{ --L'Z-j,� rFACSIMILE Z 'cl� Sl-i —Z.Z,-L�— <br /> TENTATIVE'APPOINTMENT DATE_ TIME VLA <br /> (Please give 7 to 10 business drys from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FE -REO ST PROCESSSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �MiW Cv. AA�_ p��4sAes�aDnnDTE 9114 ,0Z <br /> I 1 n 0!119 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> \.J`\,/ PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE 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 /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ 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 $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 <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> n nI.un1 --_ <br />