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r 03/1 1/2002 09:17 FAX 209 948 0621 BLEINFELDER . [a002/002 <br /> v EHD LOG NUMBER <br /> DATE RECD <br /> SAN AQUIN COUNTYPUBLIC HEALTH VICES 19M AM <br /> ��� f f lE^NVIRONMENTAL'HEALTH DIVISIO jaw <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> 02 BLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 0 d"'Z. BUSINESS/AGENCY :nre- Ic�-er <br /> ADDRESS $v� J- 1w,"7r-+1-e- S-I r c ,t- <br /> PHONE - 3 e-1,5 FACSIMILE 4{q^ <br /> TENTATIVE*APPOINTMENT DATE��� " TIME <br /> (Please give 7 to 10 business ay date of pUeation submittal) <br /> ® CHECK BOXTO EXPEDITE F -RE � S iN 3 8USINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> �.��6' "� `'� '�i�`�' -- <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 3� nng CR <br /> E rpt +. �-lor k�o� CA► <br /> ✓f 3oa3 ,C. ter.-F+�e sf S�ck�-. c� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> PEAR 18 CU�7 <br /> ieuNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT .CrSOUD WASTE FACILITY <br /> j2r OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 2T SOLID WASTE VEHICLE <br /> •Cly UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> .W HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> Z-nERD PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> E <br /> 0 TATTOO/SODY PEIRCING ❑ POOUSPA - ' ❑ MND USE APPLICATION SITES <br /> P-MEpICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 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 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$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 0".7100 <br />