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rl{LA1 : NOA Environmental PHONE NO. : 209 369 4228 <br /> UA I E RECENEII Dec. 03 2002 02:54PM P2 <br /> + n�lt-;(lel (�`t�( '�1�7AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> E"oyocauaeea <br /> ENVIRONMENTAL HEALTH DIVISION ��� <br /> DEC 0 3 2002 v 304 EAST WEBER AVENUE, THIRD FLOOR I <br /> STOCKTON CA 95202 <br /> EWPONMENT HFALTH (209)468.3420 <br /> FFRP:IIT/SFRVICPa.BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_ C.G <br /> YCld� F- O <br /> j E1BUSINESS/AGENCY 46k F_NV) EDrtM <br /> IENTA� <br /> ADDRESS.. 2-7- 7r()V r T W LAI�JE 1-01>1 <br /> PHONE (PI _4'L+74--44z0 FACSIMILE (7.09) 344 -47.Z ? <br /> TENTATIVE*APPOINTMENT DATE TIME 10••Lm Gm / <br /> (Please give 7 to 70 business days from date of application submittal (��I <br /> [3CHECKBOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 Ut Cya 71 � l�I:I CA J <br /> SIGNATURE OF APPLICANT Z& DATE (Z-3-OZ- <br /> FILE <br /> Z-3-OZFILE ADDRESS , I L-04i gSKPROGRAM_ELEMENTS SEARCH <br /> O THIS SIDE EHD STAFF USE ONLY <br /> caM <br /> I +t29 )J•Gvi Avc. Ibis's N. Gv;ld . )� - :2e :._ .�,/ I• <br /> 1 cmad W <br /> ✓✓ 1110 ic4w <br /> q2io V;CAW <br /> 8 ;C t <br /> D0 r <br /> 0 7- rN4, C I.I Aw- IVI <br /> ✓ 4( E. C4. <br /> 1,533E. `1 V✓vLtw` led. i A <',T 7 't" / °,� <br /> ENVIRONMENTAL HEALTH DIVISION FILES \4 L^r' C' <br /> 9l UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> % OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGMEMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> M HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 104 TIERED PERMDTED FACILITY b MOTF MOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM IA 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 retumed 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 /> 51 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. 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 />