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i <br /> 04/15/2002 14:56 2094FJ AGE STOCKTON PAGE 01/01 <br /> kHl,Luli Nunnurx <br /> \VI DAieltECk�YEo CQUIN <br /> CO •�p� p AVICESSAN J COUN t 6 PU.®L!C HEALTH <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> ' IJ4. 0111116 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR j6A--ke <br /> STOCKTON CA 95202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> `;l ✓ BUSINESS/AGENCY <br /> A UCAII c <br /> ADDRESS <br /> A 1�!FACSIMILE i <br /> PHONE <br /> TENTATIVE"APPOINTMENT DATES Q v t TIME <br /> (Plebe v 1� bys from to of app TIME <br /> submittal) <br /> CHECK BOX TO EXPEDITE REQU T-S 8. 0 FE - E T P 1 BUSINESS DAYS <br /> ATE �/J c:2 _ <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> r 1"z'1 r1� UY10 is <br /> 10 111, <br /> Q Q Q <br /> •� a / !/ �I <br /> � f <br /> r n a PR � nom <br /> r <br /> u Ta i L d `l <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ SOUD WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILttY 0 DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL. 0 PKO TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCK/YARD/CHEM-TOILETS <br /> TIERED PERMITTED FACILITY ❑ MOTEIJHOTEL ❑ LAND USE APPLICATION SITES <br /> 0 TATTOO/BODY PEIRCING 0 POOUSPA 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 0 MEDICAL WASTE FACILITY 13PUBLIC WATER SYSTEM <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 209 464-0138 or m it to the <br /> address indicated above. t If any EHD flies exist. An appointment for review will be confirmed <br /> 2. EHD will notify the applican <br /> approximately five business days but no later than ten (10) days after <br /> f te rn ntipt shoo dof pli scheduled led files <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 immediately available for review. A.new <br /> application may be submitted when the file IS available. EHD staff at the expense <br /> 4, Any fila not returned in the same condition as released applicant may require a$78 <br /> lreorganized <br /> y00 deposit prior to review. <br /> of the applicant. Future file reviews by the same app Y q <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 /> EATE <br /> MED APPOINTMENT DATE TIME <br /> NFIRMED <br /> PHONE FAX INITIALS <br /> D YES NO REVIEW DATE <br /> EN 00 14 01/0-WOO <br />