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q <br />;I MARCUS H . BOLE ASSOC Sao 633 0119 - 03 / 22/ 02 02 : 56pm P . 001 <br /> L SAty<- IAQUIN COUNTYPUBLIC HEALTH SEE?VICES 1 °14 Loc «uNacR <br /> r ; ENVIRONMENTAL HEALTH DIVISION <br /> 004 EAST WEBER AVENUE, THIRD FLOOR I <br /> SEP 2 2 2003 STOCKTON CA 95202 <br /> (209) 468.3420 <br /> dV! ,hUN` viLN I HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANTw �. B T SQG <br /> iNEssiAGENC"Y / f/n (a!1 C <br /> ADDRESS <br /> �DYL� G� L/ I1/ GU <br /> PHONE SJv7D 6 330 � Z _ FACCSIMILE,,11 ZJ �:71636 <br /> TENTATIVE' APPOINTMENT DATE /i SM TIMET "� C7, J - ezy sn;rlo 30G1 <br /> (Please Dive 7 to 10 nuslness days from dal* of apPlicbtlon eobmlllal) S <br /> CHECK 8Ox TO EXPEDITE REOUEST - $09.00 FEE - REQUEST PROCES D IN a BUSINESS DAYS i J <br /> SIGNATURE OFAPPLICANT �� DATE 9 2L c <br /> FILE ADDRESS THIS SIDE UHO STAFF USC ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> © (J M14919 E, .Q r w <br /> N - <br /> © r <br /> E O - tom <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> U• 61JDERGROUND TANK [UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE (NON-LOP) I3 FOOD FACILITY ❑ SDLID WASTE VEHICLE <br /> RI NDERGROUND TANK [MONITORING/REMOVAL-) ❑ DOG KENNEL O DAIRY <br /> Aa`NAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> O TIEREDPERMITTED FACILITY ❑ MOTEU140TEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOVSPA 173LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List Up to ton 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) 46400130 or mall to the <br /> address indicated above. 1 ' <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 reorganizad by EHD staff at the expanse <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 54 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 0. 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 /> nr <br /> i <br />