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FROM : NOA Environmental UMI t Ke�hIVtU PHONE NO. : 209 369 4220 Dec. 23 2002 12:24PM P3 SAN - ,AQUIN COUNTYPUBLIC HEALTH bERVICES END I,oC NUMBER ENVIRONMENTAL HEALTH DIVISION 304 EAST WEBER AVENUE, THIRD FLOOR DEC 2002 STOCKTON CA 95202 joqcr (209) 468-3420 ;P BLIC RECORDS RELEASE APPLICATION APPLICANT_�f; L !j�a�,�/ �e� i BU51NE55/AGENCY_/�yQIY rlV�rc�vt2 �,� ADDRESS ZZ i�l_ f-1ov577�.n �•- r C 550 q6 PHONE &v5 -3 76 -1 FA_k CSIMiLE 09 ' TENTATIVE* APPOINTMENT DATE �//�(O. 7r83 nME (Please give 7 to 10 business days from date of application submittal) • CHECK BOX TO EXPEDITE REQUEST - S89 O(�)_E - RE T P 4CESSED IN 3 BUSINESS DAYS Un SIGNATURE OF APPLICANT DATE 2 Z" O 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)_464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (i0) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same appllcant may require a $89.00 deposit prior to review. 5, *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE. a• DATE CONFIRMED TIME I PHONE FAX LREVIEWED YES NO REVIEW DATE •.ai I -0M: INITIALS ••'THIS SIDE EHD STAFF USE ONLY PROGRAM ELEMENTS SEARCH UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY E' OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOL1D WASTE VEHICLE a UNDERGROUND TANK (MONITORINGmEMOVAL) ❑ DOG KENNEL. ❑ DAIRY CW HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT 0 TiERED PERMITTED FACILITY ❑ MOTEL/140TEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEiRCING 0 POOUSPA a LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILrrY ❑ PUBLIC WATER SYSTEM pl OTHER (PLEASE SPECIFY ABOVE) ts.. . s r i •rZ 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)_464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (i0) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same appllcant may require a $89.00 deposit prior to review. 5, *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE. a• DATE CONFIRMED TIME I PHONE FAX LREVIEWED YES NO REVIEW DATE •.ai I -0M: INITIALS ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY E' OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOL1D WASTE VEHICLE a UNDERGROUND TANK (MONITORINGmEMOVAL) ❑ DOG KENNEL. ❑ DAIRY CW HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT 0 TiERED PERMITTED FACILITY ❑ MOTEL/140TEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS ❑ TATTOO/BODY PEiRCING 0 POOUSPA a LAND USE APPLICATION SITES 0 MEDICAL WASTE FACILrrY ❑ PUBLIC WATER SYSTEM pl OTHER (PLEASE SPECIFY ABOVE) 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)_464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (i0) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same appllcant may require a $89.00 deposit prior to review. 5, *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE. a• DATE CONFIRMED TIME I PHONE FAX LREVIEWED YES NO REVIEW DATE •.ai I -0M: INITIALS