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.__.,07/ 30/ 2002 13 : 48 209467 " " 6 AGE STOCKTON PAGE 02/ 02 <br /> tnU <br /> GATE ftEGF1VEO <br /> SAN JUIN COUNTYPUBLIC HEALTH S " . CVICES � ® <br /> IRONMENTAL HEALTH DIVISION <br /> 0 ` AST WEBER AVENUE, THIR C <br /> T STOCKTON CA 95202 f. <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION Nk <br /> APPLICANT BUSINESSIAGENCY <br /> d 1111 <br /> - ADDRESS /� /Q <br /> PHONEY �(! 7J 7(�LD _/DUKJ FACSIMILE /// INS WN <br /> TENTATIVE" APPOINTMEN70ATE -mptLd¢_ ?7ME fD ' Q � - <br /> (Ploasa give 7 to 10 basin a da from data of ap Iloatlan submittal) <br /> �, 11 BUSINESS DAYS <br /> tl� CHECK BOX TO EXPEDITE REQUE - S 0.04EE EQU RO ,-y �� a <br /> SIGNATURE OF APPLICANT DATE <br /> IF <br /> FILE ADDRESS <br /> Lt I% Kck LCKVITIP1.1 <br /> 1 <br /> t � It IL Ir ✓!la <br /> � o <br /> T <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SCUD WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL Ll PUMPER TRUCKIYARD/CHEM-TOILETS <br /> ❑ TATTOOIBOOY PEIRCING ❑ POOU$PA Gi LAND USE APPLICATION SRE5 <br /> ❑ MEDICAL WASTE FACILITY ❑ PURLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 , List up to ton 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) 484-0138 or mail to t11e <br /> addressindicated 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 avallable. <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 $78.00 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 /> 00 14 OIMN a - . <br />