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FROM Uround Zero Analysis Q � PHONE NO. : 209 838 9883 Mar. 05 2002 09:19AM P1 <br /> ,0 NtV W CU f <br /> SAN J04QUIN COUNTYPUBLIC HEALTH SERVICES otautwww <br /> I �,. ENVIRONMENTAL HEALTH DIVISION <br /> s® <br /> ' - ' ' ' - `I '304 EAST WEBER AVENUE,THIRD FLOOR <br /> 407% <br /> STOCKTON -3 295202 0 <br /> ' (209)486.3420 L' <br /> \ 02 Hl� I' -5 H 10:ft18LI6 RECORDS RELEASE APPLICATION / <br /> V <br /> APPLICANT 1Z � ,t�LG�(/\'t? <br /> j 969INESSIAGENGY �'yt %? AC1 2C.Y(� <br /> ' <br /> ADDRESS l( q ct-tfVvl <br /> PHONE �3�1 t v Og ➢ACSDdILE .�„ �.• �U. z, <br /> TENTATIVE'APPOINTMENTJDATE 3 - I TIME �t ✓ <br /> (PI sa, vo 7 t 10 1 dors fro I. t aPP'dtion submrttaU I <br /> CHECK TioX 70 EXPEDITE REQUEST. 78.00 F (eRE��S EDI BUSINESS DAYS •� - <br /> SIGNATURE OFAPPLICAN7 - "' �Sc DATE J -- <br /> I <br /> FILO ADDRESS THIS STOP END STAFF USE ONLY t <br /> PROGRAM ELEMENTS SEARCH A- <br /> \: 37 nov— i.S cJr <br /> iW11 1111-VT <br /> V a_ cin S P <br /> li I <br /> li <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> F, ** FRGROUND TANK(UST)CLEANUPSITE(LOP) M HOUSING AeATEMENT 0 SouD wASTE FACILITY <br /> Z� HER CLEANUP SITE(NON-LOP) O FOOD rAciLtTY 0 SOLID WAS VERtCLE <br /> FUNDERG ROUND TANK 1tdONITORINGlREtaOVAy ❑ DOG KENNEL w DAIRY . <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCHO PKG TREATMENT PLANT <br /> 0 TIERED PERMJM tD FACILITY 0 MOTCL'HOTEL EO PUMPERTRUCKn(ARDICHEM TOILETS <br /> TATT00:800YPe1RCING M POOLMFA 0 LAND USE APPLICATION SrrrrS <br /> MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 1209,)464.0.118 ormali to the <br /> addre"indicatgdabovej <br /> 2. EHO will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bUzin0SS days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximurn of five business days for review. Appointments should be scheduled <br /> accordingly. ii <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 avaltablo, <br /> 4. Any file not returned in the Same condition ou released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 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 processes}the next business day. <br /> ;i <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INMLALS <br /> REVIEWED YES NO REVIEW DATE <br /> $� a.rtTirvv— - TOTAL P,01 <br />