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UAI E RL-CLIVLO <br />END %OG NUMBER <br />SAN J' QUIN COUNTYPUBLIC HEALTH VICEShv: r* <br />VIRONMENTAL HEALTH DIVISI .. l LL <br />v 304 EAST WEBER AVENUE, THIRD FLOOR ' <br />STOCKTON CA 95202 SEP 3 0 2002 <br />(209) 468.3420 <br />PUBLIC RECORDS RELEASE APPLICATIONENVIRONMENT HEALTH <br />APPLICANTQ�/R�G1GG' BUSINESSIAGENCY N111— 0 <br />ADDRESS. p O / • - lvi i /1,sly lv-e �4' (I ti►C1 � C <br />PHONE - — 9 5,3 r 2 -7 9 FACSIMILE <br />TENTATIVE* APPOINTMENT DATE' ' `¢tea TIME <br />(Please give T to 10 business da froma of ap ication submittal) <br />® CHECK BOX TO EXPEDITE REQUEST - 9. 0 FEE — REQUE PROAD 1 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT ,P/}/2MAyz-`DATE °� - 30 � L <br />ADDRESSFILE <br />PROGRAM ELEMENTS SEARCH <br />�p <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br />O TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br />❑ TATTOO/BODY PEIRCING ❑ POOUSPA O LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br />Ll <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 mail 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 receipt 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 file 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 applicant may require a $89.00 deposit prior to review. <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 />•fl 111 (111(' T__ <br />