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uyi2��1UO3 11:05 FAX <br /> ��� ((1 05 FA D.' SAt�" "OAQUIN COUNTYPUBLIC HEAL" SERVICES Q 002100: <br /> .R �C, E �/ E0 --" ENVIRONMENTAL HEALTH DIV115014N <br /> 304 EAST WEBER.AVENUE,.THIRD FLOOR <br /> AUG 2 8 2003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> } E NME��T HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PEWAI 1s <br /> APPLICANT BUSINESS/AGENCY ww�� NAG't <br /> ADDRESS ovQ 1 <br /> PHONE - '� FACSIMILE A1«+0 <br /> Oil <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUES $78.00 FEE- R E T PROCESSF-D iN3 BUSINESS DAYS UA+ <br /> "8121/03 Z� <br /> SIGNATURE OF APPLICANT DATE V ZS 03 c 7�E;y5i <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILET <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 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 check <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail to tl <br /> Address indicated above. <br /> }2. END will notify the applicant if any END 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 fil <br /> 'r 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 END staff may not be immediately available for review. A N <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 END staff at the expe <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 deposit prior to rev v. <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 /> 1 CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED. YES NO REVIEW DATE <br /> EM 00 fa 0=4100 <br /> TOTAL P.Oe <br />