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04/30/2003 09:42 FAX 209 9480621 Q1002.,003 <br /> r\,- <br /> V <br /> DATE WFJVrD.1 <br /> N JOA%.,,jlN COUNTYPUBLIC HEALTH SERINES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> APR 3 0 2003 STOCKTON CA 95202 <br /> I TU (209)463-3420 <br /> EN'1' HEALk <br /> 21 C�ilrT!S I3L1C RECORDS RELEASE APPLICATION <br /> _ 1 —o F S <br /> APPLICANT Z BUSINESSIAGENCY <br /> ADDRESS <br /> PHONE qq�— 13 y FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE :!S;/7/a -,-- TIME <br /> (Please give T to 10 business days from date of application submittal) <br /> CHECK sox TO EXPEDITE REQUEST-467.00 FEE- F- <br /> REQUEST PROCESSED IN 3 BUSIN115 DAYS <br /> W1 <br /> SIGNATURE OF APPLICANT - DATE i <br /> FILE ADDRESS THIS sIE)(7'E1j_DSti'AFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> dt <br /> \j <br /> 0 '3P r_qy�+ry Ctz,.s V� <br /> COV�4r-y CI&I -RIVI, <br /> \,j qO 3 6V0%+—y clo-k 111V4 <br /> Co"4-o-Y (54vi Ah LEE <br /> \4 X-77!5 131,1 oz <br /> 'V ;2 70 9' C <br /> Cloin <br /> j <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> _21"UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ABATEMENT 0 %)LID WA�;TE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 'esclul)WASTE VEHICLE <br /> .ONDFRGROUND TANK(MONrroPJNGIREMOVAL) 0 DOG KENNEL CI DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH E3 PKrxTREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY C3 MOTELIHOTEL 0 PLIMF,F.RTRUCWYAROICHEMTOILET!31 <br /> 13 TATTOO/BODY PEIRCING o PboUSPA 13'UND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM Ll o-rHI:R(PLEX3E SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of-riles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. F_Lx t_* lall to the <br /> address indicated above.. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after Feceipt 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 rile 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 applicaht may require. a$87.00 deposit prior to reVieW <br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 31.00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL!; <br /> REVIEWED YES NO REVIEW DATE <br />