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w <br /> 08/20/2002 12:14 209e "118 AGE STOCKTON PAGE 01/01 <br /> EMO LOG NUM9ER <br /> _ ..__..__ SAeJOAQUIN COUNTYPUBLIC HEALTh eZRVICE <br /> ENVIRONMENTAL HEALTH DIVISION �� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 85202 (�(� (�E <br /> w,�f <br /> (209)468-3420 wL�V� �Vl l� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT USINESS/AGENCY y d I H H <br /> ADDRESS 49a <br /> PHONE aag) wo FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE 0M.5 <br /> m o f ap TIME <br /> submittal) <br /> (Please give T�TiRl! <br /> CHECK BOX TO EXPEDITE REQU T-$78.00 FEE ESSW IN BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE AOORESS <br /> U Q <br /> ------------ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> [I HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL 0 DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL O PUMPER TRUCK/YARDICHEM•TOILETS <br /> TIERED PERMrrTED FACILITY ❑ pOOLISPA C1 LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PEIRCING ❑ pUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <br /> e space above. Select the type(S)of files from the list above by checking <br /> List up to ten addresses In th <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)e164-0138 4r mall to the <br /> address indicated above <br /> 2, EHD will notify the applicant if any EHD files exist. An appointment for review will blelc confiTh <br /> rmed <br /> a files <br /> approximately five business days but in later y an ten (ie days ointmentspt Of shou d be scheduled <br /> will be held for a maximum of flue business days for review. App <br /> accordingly, EHD staff may not be immediately available for review. Anew <br /> 3. A file that is actively being wortced on by <br /> application may be submitted when the file is available. at expense <br /> 4 Any file not returned in the same condition as released a itl be may requirer a$78nized y E D a staff prior review. <br /> of the applicant. Future file reviews by the same apA Y <br /> 5. *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 <br /> TIME <br /> • DATE CONFIRMED <br /> PHONE FAX IN171ALS -----. <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> fN 00 14 U VV6A <br />