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02/12/2003 15:59 20946--116 <br /> AGE STOCKTON - ! „ PAGE 01101 <br /> SANOAQUIN COUNTYPUB<_IC HEALTI-r-edERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 1 jl,l 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (200)4663420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> t,111 USINESSIAGENCY <br /> �d���n�d �f?a FnurC n <br /> APPLII � NY' P <br /> ADDRESS <br /> PHONE CaDI y - �� FACSIMILE - ��11 Ll <br /> TENTATIVE'APPOINTMENT DATE <br /> TIME _ d-I I.a \.}Td7f6 <br /> (Please glue 7 to 10 business days ken data of appllratlon submittal) Lj t, . <br /> l <br /> CHECK BOX TO EXPEDITE REQU s9l oo FEE-REQUEST RO SSED IN 3 BUSINESS DAYS <br /> /SIGNATURE OF APPLICANT �e DATE. <br /> e_ <br /> FILE ADDRESS <br /> o psi _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES Kjr <br /> UNDERGROUND TANK(US 0 CLEANUP SITE(LOP) O HOUSING ABATEMENT 0 SOLID WASTE FACILI @@.,J <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICL <br /> )C.,JNDERGROUNU TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> -HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEUH(JTEL 0 PUMPER TRLICK/YARDICHEM TOILETS <br /> 0 TATTOOIDODY PEIRCING ❑ POOLISPA 0 LAND USE A11FL.ICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER(PLIJLSE 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)+5r4 138 or mall tQ the <br /> aNHfeSc indlcatgd 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..IA 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 I_HD staff aEI ft <br /> t the <br /> of the applicant. Future file reviews by the same applicant may require a$78.0 7 deposit Ivi <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 INITLA,LS <br /> REVIEWED YES NO REVIEW DATE <br /> W" 14 Y1IOL00 - <br />