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DAI I-Hf-CLAVLO I' <br /> SAN a-�QUIN COUNTYPUBLIC HEALTH SE,,,,,,CES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR JAN 0 2 2001 <br /> STOCKTONi CA 95202 <br /> (209)4GS-3420 NVI Jor4 ;ENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERMIT/SERVICES <br /> APPLICANT v. _ w` ` BUSINESS/AGENCY <br /> ADDRESS_ QO �(\��IQyjS�}y (�V2.YllA2.�. -- 1�b�/ �� jjc 1r(arnEyL�n'. �s�s <br /> PHONE 1 _'!5OO `` FACSIMILE (q U01 <br /> i"" <br /> TENTATIVE"APPOINTMENT DATE 3am—lkw �Q �1 TIME 94'550 A>YN <br /> (Pleaaa give 7 to 10 business da s from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT , c _ DATE <br /> FILE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> tj QrS k, _} S:i1d5 rl <br /> �A 3Saft1� <br /> -- <br /> - <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> E/UNOERGROUND TANK(USI)CLEANUP SITE(LOP) ❑ HOUSING ABAT"WENT ❑ SOLID WASTE FACfUTY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) C1FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ` UNDERGROUND TANK(MONfTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELfHOTE-L C7 PUMPER TRUCKIYARDICHEM TOILE I'S <br /> n TATTOOIBODY PEIRCtNG ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEO{CAL WASTE FACILITY ❑ 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)464-0138 or mail to the <br /> address indicated above <br /> 2. EHO will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business clays 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 EIHD 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 INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> -En Du 14 0=71DO —" --- <br />