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MAR-19-2003 11:58 __, - TECHN I CON rno LUG nv aw:K P•F-11 1%01 <br /> '! [- <br /> DATE RECEN-W - - - vi I! .1 ��I <br /> SAN .10. .IN COUNTYPUBLIC HEALTH SEI, CES <br /> \' MAR 1 9 2003 ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 Ijq5 <br /> ; i HLALTH (209)46"20 <br /> �E ;M,,I-I '_�EP.vICE'PUBLIC RECORDS RELEASE APPLICATION <br /> k8ONE <br /> PLICANTiFQr`hi� ROSINESS/AGENCYDRESS °ala>e^�I�II FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE. 3I�7Io� TIME <br /> (Please give T to 10 business days from dais of applieation subcnMnl) <br /> ❑ -REQUEST PROCESSED IN 3 BUSINESS DA�v s <br /> 14 <br /> CHECK BOX TO EXPEDITE RE4UE5 -Y89.00 FEE R Q J <br /> 'SIGNATURE OF APPLICANT DATE <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMEiYTS SEARCH <br /> "saw <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> x UNDERGROUNO TANK(UST)CLEANUP SITE(LOP) C1 HOUSING ABATEMENT ❑ 50LID WASTc FACILITY <br /> O OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTTE VEHICLE <br /> , _ UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL d DAIRY <br /> - �HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG PUMPER TR IIf:NT PLANT <br /> ❑ TIERE0 PERMITTED FACILITY ❑ MOTELIHOTEL O LANDER 7RUCKICATION S:M 70�I_E:'1S <br /> ❑ POOUSPA ❑ LAND USE A!'Pl•1CAT10N 31765 <br /> ❑ TATTOO/BODY PEIRCING O d OTN£R(PLEASE:SPECIFY ASOVIT) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of Tile fl•om the Ilst above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (20914p±-0138 or mall to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review vv;ll'bliC cnr The files <br /> approximately five business days but no later than ten (10) days after reCGI Shaul pli scheduled <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 Immedlalely available for review, A nein+ <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 E kit)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 Confirmad with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the neXt businoss day, <br /> CONFIRMED APPOINTMENT DATE TIME �— <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> o�vl�w�n <br /> YES NO REVIEW DATE —�=x--- <br /> TOTAL 1'.01 <br />