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i <br /> FROM NOR Erivf rarunEt std i PHONE NO. : 209 369 4228 Dec. 23 2002 12:24PM P3 <br /> urs z xa4�rvrtt . <br /> .. SAN AQUIN COUNTYPUSLIC HEALTHRVICES F"%00 m <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> DEC 2 3 20ol STOCKTON CA 95202 loqtr <br /> (209)4W3420 <br /> LNO'J.� - ,PUBLIC RECORDS RELEASE APPLICATION <br /> APPL(CMT BUSINESSIAGENCY <br /> ADDRESS <br /> p <br /> PHONE �S �3 0 FACSIMILE 4 :yj ll ?—Z CT <br /> TENTATIVE"APPOINTMENT DATE -3 TIMEfizvee:' <br /> (Ploasa plve 7 to 1Q bushiess days from date of application submittal) <br /> CHECK BOX TO EXPEDIM REQUEST-S9.O�EE—RE T P QCESSED 1N 3 BUSINESS DAYS U�SIGNATURE OF APPLICANTDAcT>= f <br /> FILE A00AESS THIS SIDE EHD STAFF USP ONLY <br /> !I PROGRAM ELEMENTS SEARCH <br /> 1 rc r Pith.. CA � l <br /> z 9Do y .G r <br /> 3 , <br /> s t <br /> (o o- <br /> 5 E7 to <br /> I r ILiht" .1s <br /> Ali t jt� is i'f'5 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> » UNDERGR60ND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Er OTHER CLEANUP srrE(NON-Ldp) 0 FOOD FACILITY O SOLID WASTE VEHICLt <br /> Sr UNDERGROUND YANK(MONITORINGIREMOVAL) ❑ DOG'KENNEL ❑ DAIRY <br /> CIE HAZARDOUS WASTE GENERATOR O CHICKEN RANCH ❑ Pl(G TREATMENT PLANT <br /> la TIERED PERMrrrED FACILrTY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARAICHEM TOILETS <br /> a TATTOOIAODY PEIRCING 0 POOLISPA r3 LAND USE APPLICATION SnVS <br /> IM MEDICAL WASTI;FACILITY s ❑ PUBLIC WATER SYSTEM 1I OTHER(PLEASE SPECIFY ABOVE) <br /> 1. ; Rist up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> :1 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 IEHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than test(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$89.00 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 -INITIALS <br /> REVIEWED YES NO -REVIEW DATE <br /> •R�t-0ltl: ^ <br />