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01/28/2002 13:29 2094677- ' AGE STOCKTGN <br /> UAYE FtCEIVFl7 <br /> J QUIN COU PUBLIC HEALTH'S VICES eeioL(�r,uma� <br /> rA <br /> ENVIRONMI; TAL HEALTH DIVISION y <br /> 304 EAST WEB R AVENUE,THIRI] <br /> S't0 KTON CA 95202 <br /> ( 09)468-3424 . <br /> D2JA�2 PUBLIC RECORD RELEASE APPLICATION <br /> APPLICANT l.e�1�� q- BUSINESS/AGENCY rppd fi I <br /> AODRES5 6 <br /> D <br /> FACSIMILE <br /> PHO <br /> l <br /> . .r .ENTATIVE"APFOINTl41ENT i7ATE' TIME p <br /> :^•r.. <br /> (Please give 7 to 10 buslne m days from data of application submittal) =► r `Y t; <br /> CHECK BOX TO EXPEDITE REQUEST-$7 0 FEE—REQ EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Z Off. <br /> FR E AooRESS <br /> d 1 <br /> 35 <br /> Sal ML - <br /> S �s - <br /> AAt <br /> �.S <br /> moi- 55 <br /> fod LD <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HO ISING ABATEMENT Q SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) © FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 12 DO KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR a CH i KEN RANCH E7 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MO LIHOTEL 0.PUMPER TRUCKtYARDICHEM-TOILETS <br /> 4 TATTOOIBODY PEIRCING D P 11SPA 0 LAND USE APPLICATION SITES <br /> ID MEDICAL WASTE FACILITY 0 PU UC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE). <br /> 1. Llst up to ten addresses in the space abo le, Select the types) of files-from the Ilst above by.checking <br /> the appropriate box(es). At least one file ype MUST be selected. Fax to 209464-0136 or mail tot e <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five business dads but no ater than ten(10)days after receipt of appftation. .Tbe files <br /> will be held for a maximum of five busine s days for review. Appointments_should be scheduled <br /> accordingly, <br /> 3. A fife that is actively being-worked on by HD staff may nut be immediately available for review. Anew <br /> application may be submitted when the f is available. „_ <br /> 4. Any file not returned In the same conditio as released will be reorganized by EWD staff at the expense <br /> of the applicant. Future file reviews by th same applicant may require a $76.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment_dates must be onfirmed with EHD staff, <br /> fi. Applications r9celved 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 /> Fx 00 14 01105ra0 - - - - <br />