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,. OAiE secweo02 14:35 2094671118 AGE STOCKTON Eno Loa r+uraGE 01/01 <br /> SAN QUIN COUNTYPUBLIC HEALTH S.- .VICES <br /> ENVIRONMENTAL HEALTH DIVISIO A hhC JE�y <br /> 304 EAST WEBERCKTON CA 9 THIRD FLOG "`J 1 ).tl ro <br /> STOCKTON CA 95202 <br /> V 111"11-. (209) 468-3420 JUL 1 <br /> 'jUBLIC RECORDS RELEASE APPLICATION 6 2002 <br /> •77//�� ,t '1 1 NT HEALTH <br /> APPLICANT U(-a BUSINESS/AGENCY of I <br /> _ RVlCES <br /> ADDRESS 0 <br /> PHONE ao9) y� � iDd6 ('�FACSIMMILc_ <br /> TENTATIVE'APPOINTMENT DATE / D TIME /D••DO <br /> ryJ/I (Please pl 7t 10 usiness d hom off appl on submittal) <br /> a 49 <br /> y� CHECK BOX TO EXPEDITE REQUE .00 F�; QUES P L�IN 3 B.. SINESS DAYS <br /> SIGNATURE OF APPLICANT / ` .O.'ale _ DATE <br /> FILE ADDRESS <br /> • <br /> c <br /> T <br /> 2S 0 <br /> I�N E . i I T <br /> 'NI ( D St 2T C F} <br /> dII Ig <br /> M r c-rTKtir c 5 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL 12 PUMPER TRUCKtYARD/CHEM TOILETS <br /> p TATTooteoDY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION Srfr$ <br /> ❑ MEDICAL WA$TE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIrY AROVE) <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 (2091464-0138 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 $78.00 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 /> 04 m 14 ovovao <br />