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02/02/2004 17:00 FAX 209 92 21 002 <br /> t.oG MUY9ER <br /> DATE A-CXNED <br /> SAN JOA4ZUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT <br /> TgKl�tS X `Y BUSINESS/AGENCY_, � <br /> ADDttEss �'Ll �e a o <br /> anq_�ryg� 3 yS FACSIMILE <br /> PHONE <br /> a 1� b 'TIME /a Aloe v <br /> TENTATIVE'APPOINTMENT DATE <br /> (plea5a give 7 to 10 business days from date of application submltSal) <br /> 00 PEE—R1 QUEST PROCESSED IN 3 BUSINESS DAYS <br /> 13 CHECK BOX TO EXPjDrM REQUEST-$87 a a O <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FII!=ADDRIrss EEE <br /> SIDE EHD STAFFUSE ONLY <br /> ROGRAM ELEMENTS SEARCH <br /> Aa L0 <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> C3 HOUSING ABATEMENT X SOLID WASTE FACILITY <br /> p UNDERGROUND TANK(UST)CLEANUP SITE(LOP) WAS-SO <br /> ❑ FOOD FACILITY ❑ LID E VEHICLE <br /> OTHER CLEANUP srrE(NON-LOP) ❑ DOG KENNEL DAIRY <br /> UNDERGROUND TANK(MONCI ORINGIREMOVAL) ❑ CHICKEN RANCH PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR p N10TELhiOTEI O PUMFERTRUCKIYARDON iTES EM (LETS <br /> ❑ TIERED PERMrrTED FACILITYtI LAND USEAPPt1CA <br /> t7 pUBUC A <br /> ❑ TATTOO(60DY PEIftCING OTHER(PLEASE SPECIFY ABOVE) <br /> 3MEpICAL WASTE FACILITY pUBLC WATER SYSTEM d <br /> 1, List up to ten addresses In the space above. Select the sel type(s)t <br /> of files from the list above r mail to the <br /> by checking <br /> the appropriate box(es). At least one file type MUST be selected. ax to 209 464-0438 y <br /> add ss indicated above. . <br /> 2. EHD will notify the business days but Dfiles exist. An no later than en (10)days after receipt of aent for review 1ppl cat on-The files <br /> approximately five busine y ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3 A file that Is actively being worked on by EHD staff may not be immediately available for review- Anew <br /> application may be submitted when the file is available. expense at <br /> 4. Any file not returned In the same condition as released <br /> will <br /> may require a�87eorganized Yo Hdeposit Pr1O0t review- <br /> 5. <br /> the applicant. Future file reviews by the same app Y <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff, <br /> 6. Applicata In s received after 3:00 pm will be processed the next business day. <br /> rj <br /> FDATECONFIRMeD <br /> ED APPOINTMENT DATE <br /> TIME. <br /> PHONE FAX <br /> INITIALS <br /> REVIEW DATE <br /> ITEC <br />