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�( AuFjoy28 . 20 03 916,4M CONDOk EkNiH TECHNOLOGIES No •4816 P . 1%I <br /> _V �-` ? �I LOG NUMCER <br /> / <br /> 7�;1�� SAN J04-WIN COUNTYPUBLIC HEALTH -S, VICES <br /> ENVIRONMENTAL HEALTH DIVISION ✓✓✓�JJ <br /> AUG 2 9 2003 304 EAST WESER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRUNMENT HEALT H (209) 468-3420 <br /> °ERMIT�SFRVICFS PUBLIC RECORDS RELEASE APPLICATION <br /> APPIJCANT--- ; r + �e_1�,cBUSINEISS-IA_GENCY TGtr W`Tf a-�11<lc] �CXt ) <br /> PHONE_ _ � l FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE C'2OC7 3 <br /> (Please give 7 to 10 business ys from date of application submidal) ' ' y <br /> CHECK BOX TO EXPEDITE REQU - 87.00 FEE-R QUEST PROCESSED IN 3 BUSINESS DAYS ■ ■ 11 <br /> VVV/NNN��' <br /> SIGNATURE OF APPLICANT 4L DATE a� D <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> PROGRAM ELEME S , <br /> L1,1q4 <br /> Ffnil ME <br /> 02 8 a <br /> 1 4`21 L' <br /> 3 rI' <br /> aa-6 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST) CLEANUP SITE(LOP) t7 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH Q PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELJHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOISODYPEIRGING ❑ POOLlSPA - • in LAND USEAPPLICATION SITES <br /> MEDICAL WASTE FACILITY PI 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)464-013$_ or.Mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD Flies 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 $87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be Confirmed with EHO staff. <br /> 6. Applications received after 3.00 pm will be processed the next business day. <br /> av� <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />