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03/21/2002 08:33 209;67118 AGE STOCKTON PAGE 01/01 <br /> E140 LOG NUMGS;A <br /> O SOAQUIN COUNTY . • <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 0 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95:02 <br /> r; id I :'! `, ;,.•c (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APHLIL � � BUSINESSIAGENCY <br /> ? �1 — 1- <br /> ADDRESS .7 CC 6 <br /> PHONE ao9) y� �ioo6 FACSIMILE [.�7262 1 <br /> TENTATIVE'APPOINTMENT DATE "Jk TIME o <br /> (Please <br /> /�21ve-7 tO 10 )ness days fro date of aP licalion submittal) <br /> CHECK BOX TO EXPEDITE REQ EST,$78.00 F - ST P90364 NESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> 351 <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 O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELnfOTEL O PUMPER TRUCCKfYARDICHEM:TOILETS <br /> ❑ TATTOOfBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE 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 to (2091464-0138 or mall to the-0138 or mall 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$78.00 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 /> eN an 14 avow" <br />