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07-24-2001 10;20FM Fk_ TU 19254260196 P ' <br /> SAN' cJ AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> b :ENVIRONMENTAL HEALTH DIVISIGN rrr/// <br /> 304 EAST WEBER AVENUE.THIRD FLOOR / ; <br /> STOCKTON CA 95202 �5 <br /> (209)468-3420 <br /> p P�UBC11pC� RECORDS RELEASEE APPLICATION <br /> APPUC.4NT� &i GfG 4 <br /> �_BUSJN£55/AGENCY v(J <br /> _ADDRESfi / � / <br /> PHONE (Q' 1 Z F� `FACSIMILE <br /> - <br /> 200 <br /> J 2 1 <br /> TENTATNE'APPOIttTMeNT DATE TWE <br /> t�1 (PIM450 om T/t b-v zusi aays Srom tlata oI appli YVAE svMn)tw71 <br /> Q CHECK BOX TO EXPEanE REWES} ,pp FFA-REEQUES�ROCiS�51ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /S DATE <br /> FaE AJ]DRF54 PUS SIDE END STAF USE ONLY <br /> PROGRAM ELEmEWTS SEARgt <br /> -------------- <br /> V, <br /> ENVIRONMENTAL,IIEALTK DIVISION FILES <br /> UFID£RGROUNC TANK(USTI CL&XAAUP SITS(LOP) t3 HOUSING ABATEMENT Q $OLIO WASTE FACILITY <br /> OTHER CLEANL}P srrF(NON-LOP) O FOOD FACILITY <br /> d UNAFRGROLWO TANK(MONrrGMNGIREMOYQ SOLD)WASTE VEHICLEHAZAALI Q DOG KERNEL WA5TCENkRATOR O DA Y <br /> TIERED PARNITTM :ACIUTACH O ENG T& <br /> CATMENT FLAW <br /> O e PSIRC44G d MOTEUHOT£L O PUMPER TRUCWYARDICH <br /> EM TO <br /> ILETS <br /> O MEDICAL WASTEFACILITY b POOLFPA '- O LAND USE APFUCATION SITES <br /> Q PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVEJ <br /> 1. List up to ten addressesiin the space above. Select the type(r)of rites from the listabove by checking <br /> the appropriate box(es),!At least one file type MUST be selected, pa <br /> addre s Jnd- ted abnve•. x lO 1209)464-093-_�C[hail to Me <br /> 2, END will notify tile applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five busin96S days but no <br /> will be held for a maximum of five businelater than fen(10)days alter receipt of application Tete tiles <br /> accordingly. ss days for review. Appointments should be soheduled <br /> 3• A rile that is actively belrig worked on by EHD staff may nut be imm0diately available for raview. A new <br /> application maybe submitted when the flie is available. <br /> 4- Any file not returned in ttie same condition as released will be reotganixad by EHD stiff at the expense <br /> of the applicant. Future file reviews bythe same applicant may require a 587.00 deposit prior Ie review, <br /> 6. 'TEN cATJVE appointmor4t dates must be confirmed with E)iD staff. <br /> pp Mons received atter 3:00 pm will be pmee93ed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED PHONE <br /> FAX INITIALS <br /> REVIEWED] <br /> a vo H rororaloe YES NO REVIEW DATE <br /> TOTAL P.02 <br />