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DATE RECEIVED SAN JL'6' F/R <br /> OAN COUNTYPUBLIC HEALTH SEPICES <br /> ENVIRONMENTAL HEALTH QLYLSION <br /> T WEBER AVENUE, THIP <br /> STOCI(TON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIO54Av 2 8=2002- <br /> APPLICANT_ BUSINESS/AGENCY con�c' fia <br /> ('--�- .y��,� p � Z t C <br /> ADDRESS � F (� )eS� i ri•I r�J Gii t 1 -}�� PERMIT/SERVICES �J <br /> PHONE FACSIMILE - <br /> s <br /> TENTATIVE'APPOINTMENT DATE jurp, 06L TIME <br /> (Please give 7 touAl%day dWS a appl on sub I) <br /> CHECK BOX TO EXPEDITE REQU 7-$87.D0 R QUE T PROCESSED IN BUSIN�S D YS <br /> SIGNATURE OF APPLICANT DATE _ 07, <br /> FILE ADDRESS _ THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> an 11,0 16t,Af N <br /> a <br /> orr Ar� <br /> 66A 5 AJ £,fj2r�Y7� <br /> 'D LOU <br /> / N - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> I UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q0.-SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> y UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOLBODYPEIRCING ❑ POOL/SPA ` - ❑ LAND USE APPLICATION SITES - <br /> -MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 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 /> 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 /> 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 /> 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 /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm will be processed the next business day. <br /> ONFIRMED APPOINTMENT`DATE TIME " <br /> kTE CONFIRMED PHONE FAX INITIALS <br />