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04/15/2002 14:56 2094r- 118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEIVED kNU LU6 NUMU" <br /> SAN MAQUIN COUNTYPUBLIC HEALTH -,"ERVICES <br /> ENVIRONMENTAL. HEALTH DIVISION �tL2 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> MewAAiJCANT11AIPP.(A hBUSINESSIAGENCY AM <br /> ADDRESS LJ <br /> 39 <br /> PHONE ! OD s- <br /> QFACSIMILE <br /> TENTATIVE'APPOINTMENT DATE �+ Q r� TIME � ✓ d$ Qr ) <br /> (Please v 1 bus6i ys from to of app cation submlttal) <br /> CHECK BOX TO EXPEDITE REQU T-$ S. 0 FE� t TP I BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> �. r Mon una 1 It. <br /> ,'7 d 't V s t, <br /> Q Q f LAI t` of <br /> ,C F D <br /> !a - n 5 ra ccc <br /> SJR 3s� <br /> n Q 35"z c, LJ <br /> r 35-)-4 <br /> 35P9 k 24 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 17 SOLID WASTE VFHICI_F <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELJHOTEL 11 PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOO/BODY PEIRCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MFDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space abov©. 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 (2091464-0138 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 <br /> should pli schedules files <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <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 578.00 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 PHONI: FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 is o�rosroo <br />