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-____A7/30/2002 13:48 209467 AGE STOCKTON PAGE 02/02 <br /> DATE RECEIV[p / <br /> SAN�JO IN COUNTYPUBLIC HEALTH #VICES <br /> IRONMENTAL HEALTH DIVISION <br /> N 3 D AST WEElER AVENUE,THIR <br /> STOCKTON CA 95202 ✓-. <br /> (209)46a-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION Nk <br /> APPLICANT a QrMBUSINESS/AGENCY <br /> ADDRESS Q <br /> PHONE a0 <br /> 93 <br /> yaj /ow FAGSIMILE,yy� C <br /> TENTATIVE'APPOINTMENT DATE TIME JD 010 <br /> `}pt/ (Please GIVa 7 t{°/�/1aO�blU�s s da from data of ap Iication submittal) <br /> 414 CHECK BOX TO EXPEDITE REQUE -S e.00 FEE—RE'U RD L&14USINESS DAYS �� a <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> to t rbA <br /> Asaq nor <br /> Al a e <br /> / I <br /> 1l It it it ✓Ila <br /> f` <br /> remMn <br /> T <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMrrTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATT001BODY PURGING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PU.BUC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209 464-013Q or mail to t <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for revlew 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 $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 processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 9H 00 14 olmlim - <br />