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ffrr 01/28/2002 13:25 204467 AGE STOCKTC,N ,'alae JG, i1L <br /> DATE 134CEIVED EMO LOG NUMDEa <br /> J QUIN COU TYPUBLIC HEALTH S VICES <br /> 11\,1h���� t1 �F IGIp 304ENVIRISION <br /> EASOTJMENTAL W B RAVEN ELTHIRDHEATH IvFiA <br /> STO KTON CA 95202 <br /> p2 Ja�2� PH`2 <br /> 09 <br /> PUBLIC RECORD RELEASE APPLICATION <br /> APPLICANT l..B. QA$D BUSIN SS/AGENCY <br /> ADDRESS Q <br /> PH0 FACSI ILE <br /> �P �ENTATIVE'APPOINTME DATE TIME ' IS"ctj.'➢] <br /> A � 1 <br /> " (Plea a gWa 7 to 10 dusine days from date of application submittal) ` 'W ,,.+'� <br /> /1/4// 21 <br /> CHECK BOX TO EXPEDITE REQUE T.57 0 FEE—REQ EST PROCE SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 g 02 <br /> FI ADDRESS <br /> 0 1 <br /> 3Sz <br /> S 5S <br /> ` ,y8 <br /> ,� 55 <br /> R .(ad I.D .2 <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEA P SITE(LOP) ❑ HO SING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FO D FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORIN EMOVAL) ❑ DO KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHI KEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MO LIHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> * TATTOOIBODY PEIRCING ❑ P LISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PU UC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten address s in the space abo e. Select the type($) of files from the list above by checking <br /> the appropriate box(e . At least one file ype MUST be selected. Fax to (209)464-0138 or mail to the <br /> addressIndicated a b o e. <br /> 2. EHD will notify the ap licant if any EHD fi es exist. An appointment for review will be confirmed <br /> approximately five bu iness days but no ater than ten(10) days after receipt of application. The files <br /> will be held for a maxi Um of five busine s days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is.actively b ing"worked on by HD staff may not he immediately available for review. A new <br /> application may he su mitted when the Ti is available. <br /> 4. Any file not returned I the Same Conditio as released will be reorganized by EHD pstaff at the expense <br /> of the applicant. Futu a file reviews by th same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be onflrmed with EHD staff. <br /> 6. Applications received after 3:00 pm will b processed the next business day. <br /> ERIEWE <br /> NFIRMEDAPPOINTMEN DATE TIME <br /> ECONFIRMED PHONE FAX INITIALS <br /> EM 00D YES NO REVIEW DATE <br /> 76 01105100 " <br />