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DATE RECEIVED EHD L CG NUMBER <br /> w SAI' 3AQUIN COUNTYPUBLIC HEAL SERVICES <br /> %"', ENVIRONMENTAL HEALTH DIVhZ0'iON <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 Zow <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT S v1 v I vrV'�D�t"7/DIyr'M'BUSI ES <br /> ' 1SIAGIENCY 1 <br /> ADDRESS �� 3 l �1�r �o��C(Y1 (e JUL 1 6 2002 <br /> PHONE ( � FACSIMILE ENVIRONMENT HEALTH <br /> PERMIT/SER <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days fr date of application submittal) <br /> uw.r5 <br /> CHECK BOX TO EXPEDITE REQUEST-a8 .00 FEE—REQUEST PROCESSEDIN B NESS DAYS <br /> SIGNATURE OF APPLICANT �, k/ HDATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 7) n e -� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> / <br /> Q/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) LU HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> *OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> *UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 6 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 13 TIERED PERMITTED FACILITY MOTEL/HOTEL13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 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 $89.00 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 /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> •n 1"0mr <br />