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11/06/2000 13:02 925551- HENSHAW ASSOCIA PAGE 01/01 <br /> l'J7-17-L1�U'b le: marl FROM TO 192SSS17464 P.01 <br /> BATE RECINEWD <br /> SA OAQUIN COUNTYPUBLIC HEALTH ERVICES �He�ocnumeeq <br /> ENVIRONMENTAL HEALTH DIVISI N <br /> - � 304 BAST WEBER AVENUE,THIRD FLO R <br /> STOCKTON CA 952)2 <br /> ` (209)468-34.20 <br /> a PUBLIC RECORDS RELEASE APPL A <br /> YIoN <br /> APPUCANT �' I 1! I BUSINESS/AGENCY 60 � ., p i¢ r <br /> ADDRESS Ott b/ -5,t `T C <br /> 14-a ov� 19AL A <br /> ` /, <br /> �7vr�/Ll QZS �. � <br /> TENTATIVE"APPOINTMENT DATE <br /> TIME <br /> (Please glve 7 to'10 business days from date .)(application ul)mittal) <br /> CHECK BOX TO EXPEDITE REQUES - a7. 0 FEE—REQUEST PROCE:3SED IN 3 BUSIN S DAYS <br /> SIGNATURE OF APPLICANT DATE ��r�0 <br /> i <br /> FI DDRESS TH SIDE EHD STAFF USE ONLY <br /> PdbrPAAA x,lZMr,uTc ecA oru <br /> "fC 1 <br /> D a., t $c Lt vo 5T LJwG /C <br /> a PZ West PARC 2�, God Cd <br /> i <br /> ENVIRONMENTAL HE LTH DIASION FIL S <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATE MEI IT I SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY I SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) C 000 KENNEL r. DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br /> © TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL PUMPER TRUCK/YARD/CHEM TOILETS <br /> C7 TATTOO/BODY PEIRCING ❑ POOUSPA LAND USE APPLICATION SITES <br /> LJ MEDICAL WASTE FACILITY ❑ FU13LIC WATER SYS';'EM I OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List U to ten addresses in the space above. Select the <br /> P p type(s) off es from the list above by checking <br /> the appropriate box(es), At least one file type MUST be ;elected. E ix 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 a ppointmen for review will be confirmed <br /> approximately five business days but no later than tan (10)days afl jr receipt of application. The files <br /> will behold for a maximum.of five business days for rev ew. Appoi tments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immadiately 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,vill be reor nixed by EHD staff at the expanse <br /> of the applicant. Future file reviews by the same aprillCF nt may req ire a$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff, <br /> Applications received after 3:00 pm will be processed tl-a next busy ess day. <br /> I ; <br /> CONFIRMED APPOINTMENT DATE _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 16 08107100 <br /> i <br /> TOTAL P.01 <br />