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FROM : NOR Environmental PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P3 <br /> uwie aeUEIVEU <br /> END%OC NUMBER <br /> �) I SAN JUAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> 111�r _ I /I ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I oqtr <br /> DEC ZOOCSTOCKTON CA 95202 <br /> (209)468-3420 <br /> .PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCYMOA <br /> Virov�wE{ � <br /> ADDRESS �2 (��_ I-IOvS�,.�. _c._s � _ 'C IfZt/G <br /> PHONE&Ui).3(07—3.76 1 FA <br /> //CSIMILE 676fO 3[09 -yZ2a <br /> TENTATIVE`APPOINTMENT DATE_�l0 Z683 TIME <br /> (Please Alva 7 to 10 business days from date of appllwtion submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-98E?.0 EE-RE T P OCESSED IN 3 BUSINESS DAYS Un <br /> SIGNATURE OF APPLICANT _ _ r — DATE U Z <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> PROGRAM ELEMENTS SEARCH <br /> 880 ,� r Rd. Lcd: C19 �+" v v v <br /> C4e <br /> 9 <br /> � ni <br /> 7 0 V V ti /1 <br /> a 5 L -6 200 <br /> CA _ r Cr" <br /> `I t <br /> fee 46jljv re der y" <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> IID UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> R'OTHER CLEANUP SrrE(NON10P) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ZZ UNDERGROUND TANK(MONrronING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Cr HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOISODY PEIRCING 0 POOUSPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM P 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 ton (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should ba scheduled <br /> accordingly. <br /> 3. A Nle 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 /> N. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> es uim. . <br />