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DATE RECEIVED ry{�.��y)O Z U�/ � a EHD LOG NUm�Eft <br /> V / TT�ZJJCC77MMII''�-�S K(J'� Jf SERVICE <br /> ENVIRONMENTAL H!ATITI?`D*111 ION <br /> 6 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 AUG 2 7 2002 <br /> P/UnnBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Q Y I BUSINESSIAGENCY <br /> ADDRESS - 1 <br /> PHONE rl— U FACSIMILE .- <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please gi 7 b I e from f application submittal) <br /> CHECK BOX TO EXPEDITE REQUE - Of Q E TP E E IN 3 BUSINESS DAYS Co IMosT) <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS U IT IV <br /> / © h <br /> i 1 (/ �l <br /> n <br /> sMq— <br /> AD /)a <br /> 5/ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ER CLEANUP SITE(NON-LOP)NDERGROUND TANK(UST)CLEANUP SITE(LOP) 11 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHDAIRY <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL E3❑ PKG TREATMENT PLANT <br /> 13 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br /> ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/yARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> C3MEDICAL WASTE FACILITY <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. to appointment for review will be confirmed <br /> later than ten (10) days after receipt of application. The fifes <br /> approximately five business days but no <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 /> ECONFIRMED <br /> PPOINTMENT DATE TIME <br /> PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EH 00 14 01/05/00 <br />