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FROM NCR Environmental PHONE NO. : 209 369 4228 <br /> vrm a��r.Iveu Dec. 23 2002 12:24PM P3 <br /> - SAN , jAQU(N COUNTYPUBLIC HEALTH SERVICES 1 END 40C NUMBER <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR loqtr <br /> DEC 2 3 2002 STOCKTON CA 95202 <br /> `I iI (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT i^,/�C A .I�IQ BUSINESS/AGENCY_6 Qf} ZjaV'r� <br /> ADDRESS ZZ ,7 q6 <br /> PHONE US).3b7 .3'70 FACSIMILE_Zoq) 3/oi _yz76, <br /> TENTATIVE'APPOINTMENT DATE � L 7_063 <br /> TIME ����.._ ' -r�3 7 b� <br /> (Please give 7Z'10 business from I_,` <br /> days date of appilcation submittal) 0 <br /> CHECK BOX TO EXPEDITE REQUEST-SfFEE—RE ^T P OCESSED IN 3 BUSINESS DAYS Uhl <br /> SIGNATURE OF APPLICANT _ DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> S$Drc r Rd, /_,C(; GFi �+V V V <br /> -N �} <br /> 9�y <br /> to Q-7 0 -For V V 11 A <br /> a 5 E• L C4 _ ,r CA <br /> or, y <br /> pr,-I•�.;+s <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> M UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> RY OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> LT UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> W HAZARDOUS WASTE GENERATOR ❑ cHICKE'.N RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKlYARD/CHEM TOILETS <br /> ❑ TATTOOMEDICAL <br /> WASODY PEIRCILI O POOUSPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM I$ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of flies 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 /> 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 $89.00 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 />