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04/15/2002 14:56 2094' 118 AGE STOCKTON PAGE 01/01 <br /> DATE RECkIVGO kHU LUG NUMUrJt <br /> SAN ,jOAQUIN COUNTYPUBLIC HEALTH __-RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> �,.11, PUBLIC RECORDS RELEASE APPLICATION <br /> AP�LJCANT BUSINESS/AGENCY <br /> ADDRESST9svzo <br /> /� a �J PHONEa�/ / <br /> FACSIMILE) <br /> TENTATIVE APPOINTMENT DATE�G� Q ral TIME ' vee �rlar � <br /> (PleaseMA <br /> 1 buses ys from to of app cation submittal) <br /> CHECK BOX TO EXPEDITE REQ U T-3 8NOFE E TP I BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> ,27 d '` V 394,Sz L <br /> l� '� 4 3� t, <br /> p GL f w t• ►r <br /> Dj S2k $ S End <br /> �a n m CCS <br /> n Q 351.7,c, Lj <br /> r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VFHICLF <br /> OTHER CLEANUP 917E(NON-LOP) p DAIRY <br /> UNDERGROUND TANK(MO NITORINGIREMOVAL) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GFNERATOR ❑ CHICKEN RANCH <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL El PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOO/BODY PEIRCING Il POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q 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(es). At least one file type MUST be selected. Fax 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 appointment for review will be Confirmed <br /> approximately five business days but no later than ten (10) days after receipt <br /> should pli sched led files <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 immedlately available for review. A new <br /> application may be submitted when the file Is available. 9 EHD staff at the expense <br /> 4, Any file not returned in the same condition as released <br /> will <br /> be reorganized <br /> a $8y00 deposit prior to evlew• <br /> of the applicant. Future file reviews by the same app Yrequire <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 /> EH 00 to o+rouoo <br />