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05/09/2002 15:11 20946- 18 AGE STOCKTON PAGE 01/01 <br /> t;wut ncCcrveu EHO 100 NUMBER <br /> SANS'OAQUIN COUNTYPUBLIC HF -ERV ! <br /> V IRONMENTAL HEALTH DIVISION <br /> ►�( AST WEBER AVENUE,THIRD FLOOR C,�_;, I <br /> fjE <br /> S70CKTON CA 95202 <br /> t (209)468.9420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT U BUSINESSIAGENCY �/ �• <br /> ADORE SSQ <br /> PHONE ao9) V/0 �7 10616 FACSIMILE n/ <br /> TENTATIVE*APPOINTMENT DATEAl 131 ,1)604Z Cn+OA ME bCf'V V <br /> (Please give Tart3 M d Of appll tion submittal). <br /> CHECK BOX TO EXPEDITE REQUE -$78.00 FEE-REQUEST PRO IN 7 SINESS DAYS S_ <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> o ckmn s� $ <br /> d y SID <br /> or 761CK7Dn <br /> A " <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 ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 173MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODV PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACIUTY ❑ PUBLIC WATER SYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses In th'o 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 (2091464-0138 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. Anew <br /> application maybe submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EMD 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 /> EM oo �+ oirosmn <br />