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r 00/2003 09:42 FAX 209 9480621 <br /> X1002 001 <br /> DATE \ — ;1 EXD lOG nUNBFR <br /> ,rl)(j__ �J� �� �,�� �hr- jSAN JG'MUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 349 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 I <br /> cNVlrvliMtPdl HEAL�x � (209)468.3420 <br /> 0A' ,sFwir,F, �'uBLIC RECORDS RELEASE APP <br /> LICAI"ION <br /> APPLICANT /fQ� BUSINESSIAGENCY <br /> ADDRESS._ S-�- <br /> PHONE yydf — /3�-/S FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE 5/ /V 3 TIME <br /> .(Please give T to 10 business days from dale of application submittal) 5 L <br /> 13 CHECK BOX TO EXPEDITE REQUEST•$67.00 FEE-REQUEST PROCESSED IN 3 BUSINEI3S DAYS 7 / � <br /> If <br /> ,-4 <br /> SIGNATURE OF APPLICANT _ DATE l v_! '�7 <br /> FILE ADDRESS THIS SIDI:EHD STAFF USE ONLY <br /> PROGRA61 ELEFAENTS SEARCH <br /> /876 Cou..+r Clams -lslt/Z <br /> 081 Ovn tr. IK � v� <br /> IO 3 +,Y (•I&N T?lv,� Li AL-C7 <br /> /`103 at�n}-r GIBS �)✓d �— <br /> / C.ON14-r C4 vk /v[ <br /> 7097 r <br /> 01.79, -T Coc *N+ry Climb 131,,E iJPAT I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> .J'uNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑�,SfILID WA;TE FACILITY <br /> OTHER CLEANUP SITE(NON-.OP) ❑ FOOD FACILITY B SCILJD WASTE VEHICLE <br /> -0-TNOERGROUND TANK(MONrTORINGIREMOVAL) ❑ DOG KENNEL D DAIR'r <br /> O HAZARDOUS WASTE GENERATOR. ❑ CHICKEN RANCH ❑ PKG'rREArMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMF'ERTRUCKfYARDICHEM TOILETS <br /> ❑ 7ATTOOBODY PEIRCING ❑ POOLlSPA ` ❑*UMV USE APPUGATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 O'rHI:R(PLEX3E SPECIFYABOVE) <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 lo l2`09) 464-0738 or mall to if e <br /> address indicated above. . <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for reviev+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 END staff at the expense <br /> Of the applicant. Future file reviews by the same applicant may requinr a$87.00 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 busine:is day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL.,; _ <br /> REVIEWED YES NO REVIEW DATE. <br />