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02/14/00 1 2::37 F,1A 9 1 S B52 034 1.0('1(1+001) CONSIXG -r l'i <br /> JA E RECEIVLG EHG LOG NUMU , <br /> SAN J,' IUiN G®UNTYPUBLiC HEALTH : VICES v <br /> V &�i 3 <br /> r-NVIRONMENTAL HEALTH DIVISIQ-4 <br /> 304 EAST WEBER AVENUE, THIRD FLOOR, <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT P-Y1CLt til-fx_{[tl; 13USINESSIAGFNCY__ }`lY�Lytp�rA +;LT +�tfl <br /> ADDRESS h ' <br /> PHONE ( — Ur,,Z FACSIMILE {ate —7rA4,nD <br /> TENTATIVE`APPOINTMENT DATE /nom TIME <br /> (Please give 7 to 10 business days from slate of application subrrnittad) I L i <br /> 71 CHECK BOX TO EXPEDITE REQUEST-$?9.00 FEE—REQUEST PROCESSED W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> oW t t '1 <br /> E H wy Iznow <br /> of r — r)o LY X44 b <br /> ENVIRONMENTAL HEALTH DIVISION FILES 0 EYE[ <br /> M'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAOUTY 13 SOLID WASTE VEHICLE FEB 22 2000 <br /> L9 UNDERGROUND TANK(MON1TOWNGIREMOVA.L} ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR C CHICKEN RANCH ❑ PKG TREATMLKT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELNOTEL ❑ PUMPER TRUCKIYARWCHEN TOLETS <br /> O TATTO(XBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List tip 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-X2093_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 $78.00 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 HATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EN 09 14 010Q:f00 <br />