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03/26/2003 11:37 2094671118 AGE STOCKTDN PAGE 11/01 <br /> DATE REiCE1VC0 4HD LOG NUM9ER <br /> SAN ,-..AQUIN COUNTYPUBLIC HEALTH ... RVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 2 6 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> I HF I' (209)468-3420 <br /> _UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT * BUSINESS/AGENCY <br /> ADDRESS-23? Q (2M 7 4;V,!I_ - <br /> Ca� 9&7- goo - <br /> PHONE FACSIMILE <br /> TENTATIVE APPOINTMENT DATE-y[j l TlME -1! — G) C >) <br /> (Please give 7 to 1h business days from date of application submittal) <br /> HECK BOX TO EXPEDITE REQ ST-$94,00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS q <br /> SIGNATURE OF APPLICANT DATE: <br /> FILE ADDRESS <br /> tna <br /> _ ___2 -- <br /> IMF <br /> ~ 7� - -:y _fTIM\ (Ws-yg \&�j <br /> t. <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES, <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT C1 SOLID WAS11:I CILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASYE:1 EHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL C3 PUMPER TRUCI ARDICHE:M TOILI'TS <br /> ❑ TATTOO/BODY PEIRCING O POOLISPA [J LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEAS 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) 4•-64,0138 or mail to_tho <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist_ An appointment for raview will be confirmed <br /> approximately five business days but no later than ten (10) days after re.r_eipt of application. The tills <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 avalla le 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 reorganir.ed by E: at <br /> of the applicant. Future file reviews by the same applicant may require a $78.0( ptnpp o e e <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 /> EH 00 14 olrosro0 — —_ -- <br />