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10/09/2002 15:20 2094771973 GREG PARKAS PAGE 01/01 <br /> - • *V+V1 J0 ENVIRONMENTAL HEt'TH <br /> ugrs kacervea PAGE 01 <br /> SAr ""OAQUIN COUNTYPUBLIC HEALTHES RVICES E-�Qc04U OM <br /> ENVIRONMENTAL HEALTH DIVISION <br /> O 304 EAST WEBER AV)=NUE,THIRD FLOOR ' 1,124STOCKTON CA 95202 <br /> 9 <br /> PUBLIC RECORDS RELEASE APPLICATION -- I <br /> APPLICANT�r-1_alr l�r,,I \! Fn) <br /> U BUSINESSIAGENCY <br /> ADDRESS ��v�� <br /> OCT 1 0 7RZ <br /> PHONE ZO?—4-7'7 —19-7 <br /> FAt:sIMILE . HEALTH <br /> TENTATIVE*.APPOINTMENT DATE TIME � ` , PERMIT/SERVICES <br /> (Pfcasa gJve T to 10 business,jim fr data o[ pilcation submillaQ <br /> CHECK BOX TO EXPEDITE REQUEST pp � T p <br /> E N 3 6USiNE$S DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FILE ADDRt;SS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> � 1'7b rw do <br /> /� ENVIRONMENTAL HEALTH DIVISION FILES <br /> �,f�NDRRGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT O 90LID WASTE FACILnY <br /> Jam_iVTHER CLEANUP SITE;(NON-Lop) C1 F000 FACILITY ❑ SOLID WASTE VEHICLE <br /> rrdd UNDERGROUND TANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> R(HAxARDOUS WASTE GENERATOR to CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILFTY 0 MOTELMOTEO ❑ PUMPER iRUCKNARD/CHEM TOILETS . <br /> ❑ POOLISPA d UAND USE APPLICATION SfTEs <br /> Q MEDICAL WASTI?FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEAS!:SPCCIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the typo(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be Selected. Fax to 1`2091 464-0938 or mail to the <br /> Address indicated above. - <br /> 2. EHD will notlfythe applicant if any"EHD files exist. An appointment for review will be confirmed <br /> approximately fivo business days but no later than ten (10) days after recoipt of application. Tho files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fife that.ls actively being worked on by EHD staff may not be immediately available for review_ A new <br /> application may he submitted when the file is available. <br /> 4. Any file not returned in the same condition,as released will be reorganized by 1CHD 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 /> 'TENTATIVE appointment dates must bo confirmed with END staff. <br /> 8. Applications received after 3:00 pm will be Pro4 cwmed the next business day. <br /> F <br /> NFIRMED APPOINTMENT DATE, TIME <br /> TE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NOREVIEW DATE <br /> . r <br /> n <br />