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Jan- 12-00 02 :32A Neil O- Anderson & Assoc- 916 929 9269 P .01 <br /> SAM kAQUIN COUNTYPUSLIC .HEALTH SACES <br /> ENVIRONMENTAL HEALTH DRASION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (204)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ` �� � J <br /> �([� y1 aUSINES5IAGENCr <br /> ADDRESS_�y4� �Gi ��rTC klnAn 4e 3V�1 �ri �b S _L��MEy CA GPS b'3�f <br /> PHONE "Ilio-9 3 FACSIMILE al: <br /> TENTATIVE"APPOINTMENT DATE______ TIME <br /> IPlraee pine 7 to SD huaineaa days from dme afapplicaHon auemllmT) <br /> CHECK BOX TO FXPWITE REQUEST <br /> /-S7B.00 FEE REQUEST PROCESSED e1 3 BUSINESS DAYS _ <br /> SIGNATURE OF APPLICANT �{ �h ,n6 DATE ti i i <br /> FILE ADDRESS <br /> L <br /> V <br /> l- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ar UNDERGROUND TANK JUST)CLFAXUP SITE(LOP) O HOUSING ABATEMENT 17 SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NQN.LOP) ❑ FOOD FACILITY D SOLID WASTE VEHICLE <br /> .,/UNDERGROUND TANK(MONRORINWRENOVALT a DOG KENNEL ❑ DAIRY <br /> ii HA:AROOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACRITY ❑ MOTEU110TEL O PUMPER TRUCKIYAROICHEM TOILETS <br /> O TATTOOMODY PEIRCIN(i O POOL'SPA D LAND U SE APPLICATION SITES <br /> n MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OTHER{PLEAS!SPECIFY ABOVE) <br /> 1. List up to ten addresses In the apace above. Select the types)of files from the list aboveby checking <br /> the appropriate box(es). At least one file type MUST be selected. Facto(209)464A138 or mail to the <br /> address indicated above. -- <br /> 2. EHD 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 tiles <br /> will be hold for a maximum Of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fife 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 expanse <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to revtgw. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received attar 3:00 pm wITT be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITLALS <br /> REVIEWED YES NO REVIEW DATE <br /> r �w,er �y�yyy <br /> IF I i � TOTflL P.02 <br /> ED <br /> JAN 12 2000 <br /> i' <br /> _N'ViHON1ME N1AL- �i=ALTH <br /> �} ane& 4t c 1 -13 HERMIT / SERVICES <br />