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ul/ti�7/2002 16:OJ lUgciC,77`]'' <br /> Aub.S i lJt �lJ 4 EHD LOG N010611 <br /> uaicnc�rveu <br /> OUIN COUNTYPU6#�lC HEA ICES <br /> SAN S ' <br /> ENVIRONMENTAL HEALTH DIVISION <br /> S304 EAST WEBER AVENUE,THIRD FLOOR <br /> tJ STOCKTON CA 95202 ��� <br /> j (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APFLIGANT �y6USlNESS1AGENCY <br /> A <br /> ADDRESS <br /> PHONE YVIP771040k--F. CSIMILE /J I / <br /> 11/0Z TIME ![�]''1/w <br /> TENTATIVE*APPOINTMENT DATE application submittal} <br /> (Please give to 1 lim ness days from date of app <br /> 6AU17-5 2, <br /> CHECK BOX TO EXPEDITE RI QU $78.00 FEE—RE U ST PR ESI IN 3 BUSINESS DAYS <br /> � DATE <br /> -7-LAK <br /> SIGNATURE OF APPI_.ICANT <br /> Flf�ADl3RE55 <br /> a <br /> r 1 rr <br /> 3 <br /> It �r <br /> EHVIFt�NMENTAL HEALTH DIVISIQN FILES <br />` EISOLID WASTE FACILITY <br /> UNDE=RGROUND TANK(U"CLEAtIUt'&I'{E(LQI') C} HOUSING ABATEMENT <br /> OTHER CLEANUP SITE(NON-LOP) .0 FOOD FACILITY 0 SOLID WAS1`I=VEHICLE <br /> UNDERGROUND TANK(MIONITORINGIREMOVAL) IM DOG KENNEL © DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ PKGP R TRU NT PLANT <br /> E TIERED PERMITTED FACILITY 0 MOTEL/HOTEL ❑ PUMPER E APPUYATION SITF-S LETS <br /> I C] LAND USE APpLICA"1'ION S17>=S <br /> ❑ TATTOO/000Y PEiRCING 0 POOLISPA <br /> ❑ MEDICAL WASTE FACILITY Cl PUBLIC WATER SYSTEM E3 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(ps). At least one file type MUST be selected. Fax o 2 9 4 -0138 o %11 tq.the <br />` a r s Indica# d v <br /> 2. EHO 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 maxim-urn of five business days for review. Appointments should be scheduled . <br /> accordingly.,, <br /> 3. A file that is actively being-work6d'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 retarded 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 i,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 <br /> NO, REVIEW DATE <br /> EH 00 14 011136rdn ' <br />