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MAR-08-2_0_02_ 16:27 CAMBRIA 1707 935 6649 P.01101 <br /> l"0 LWNUMNLK <br /> #-Iq _. T SAN J AQUIN COUNTYPUBLIC HEALTH SERVICES 7 iz <br /> ENVIRONMENTAL HEALTH DIVISION <br /> i •:. i I(= �-71' 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> -3 pia tPALIC RECORDS RELEASE APPLICATION <br /> iirr a <br /> APPLICANT > (Zoo _BUSINESS/AGENCY �- �� Y1V t rOlnrYl� (nil <br /> ADDRESS O �111C, S#ru SOY!Ow+2i CA d <br /> PHONE (707 933- 23(68 FACSIMILE 0017 649 <br /> TENTATIVE'APPOINTMENT DATE 9 TIME O d O <br /> ( aa ��v T to�rt days ate of 8p !cation submittal) <br /> El CHECK SOX TO <br /> EXPEDITE <br /> RE E --S8 0IFEE. R EST P ED IN BUSINESS RAYS <br /> SIGNATURE OF APPLICANT ^� DATE <br /> FILE ADDRESS THt.S SIDE EMD STAFF USE ONIY <br /> PROGRAM ELEMENTS SEARCH <br /> q4 l W. • h S c t a 4 <br /> 506 W. r1r W 3S a�• <br /> L��ncolh q3sa�v <br /> t;t to Sh-e.c f l�- sat, s <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> V14UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> X.OTHER CLEANUP SITE(NON-LOP) CI FOOD FACILITY CI SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> d HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C] PKG TREATMENT PLANT <br /> ❑ TIQReD PSRmr T$D FACILITY ❑ MOTFUNOTEL ❑ PUMPER TRUCKrYARDIcH1=M TOILETS <br /> ❑ TATTOO/BODY PEIRCING C7 POOIJSPA - - C2 LAND USE APPLICATION SITES <br /> D MEDICAL WASTE FACILITY D PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-013$ 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 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 available. <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$87.00 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 CONFIRM!=D PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL P.01 <br />