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DATE RECEIVED <br /> EliD%0G NUMBER <br /> w SAN ,"AQUIN COUNTYPUBLIC HEALTH gERVICES <br /> _NVIRONMENTAL HEALTH DTVI: N <br /> 304 EAST WEBER AVENUE, THIRD FLOOR is <br /> STOCKTON CA 95202 <br /> X An <br /> (209) 468-3420 n � <br /> PUBLIC RECORDS RELEASE APPLICATION Ill D <br /> APPLICANT C�4� �� � l�/�r`rBUSINESSIAGENCY ` -�� LG�S� Jl1N 9 2002 <br /> ADDRESS <br /> PHONE -512 7-- -. 4- LTH <br /> FACSIMILE PERMIT/SERVICES <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> uAll S .:5. <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST P ESSE IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANIK PD A4T E <br /> �— <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS S ARCH <br /> / TZ Zolak.0o Meg <br /> Innnn <br /> \, UUU <br /> D - I <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> -ffl�UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> -0—OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> __[:�- gNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> -HAZARDOUS WASTE GENERATOR - <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE 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) 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 /> •n ni nnr — — — --- <br />