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FROM NOR Environmental <br /> uwi a Ke�kiVtU PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P3 <br /> IC�I(r: <br /> SAN J%,, QUIN COUNTYPUBLIC HEALTH SERVICES END 4aa NUMBER <br /> 'ii ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> 3 200( STOCKTON CA 95202 loqtr <br /> (209)468-3420 <br /> ;.:PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESS/AGENCY Al DAyir o�vh�„ � <br /> ADDRESS ZZ <br /> &05);&7 <br /> PHONE 05)Sb7-37D / FACSIMILE_(Z-69) -yo IT <br /> TENTATIVE'APPOINTMENT DATE ld, 7-68-3 q I_ �3 7G/-CrJ <br /> TIME /���--►._ � ?. i _ <br /> (Please Dive 7 to 10 business days trom date of application submittal) <br /> CHECK BOX Tp EXPEDITE REQUEST-589.00 E-RE Y P OCESStrD IN 3 BUSINESS DAYS Uh I*f <br /> SIGNATURE OF APPLICANT <br /> DATE Z" D Z <br /> KILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH O <br /> 3 <br /> � . <br /> ' 9 <br /> to � 41� a� <br /> 0 <br /> �1 00 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ad UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 0'r HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING CI POOL/SPA ❑ LAND USE APPLICATION Srrrs <br /> ❑ MEDICAL WASTE FACILITY O PU13UC 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 then 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 /> a - <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />