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rIO : NOA Environmental PHONE NO. : 209 369 422E Dec. 03 2002 02:54PM P2 <br /> UAI k KVCENED <br /> (��� C END X00 NUMBER <br /> 1 I_�I\L� ,���I`�'� i 'JUAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> OEC O 3 20OZ 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 0&5 <br /> i:.��VIUCIi�41�1ENT EIF.ALTH (209)468.3420 <br /> VICPVBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT A' AC_CGO. BUSINESSIAGENCY +Jb1- ENV)P-0NV4F-O T AL— <br /> ADDRESS .27' 4+;V,LS TU-?,J iA�LO-D l <br /> PHONE ��� �' - y'Z4 FACSIMILE �7-o°f� 3�6-42.2'8 <br /> TENTATIVE`APPOINTMENT DATE I� '" Z�—6 Z TIME 10 ov AIM+ <br /> {Please give 7 to ip 4usinesS days from date of application aubioys+ <br /> tt <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE.-REOUEST PROCESSED IN 3(All r J <br /> SIGNATURE OF APPLICANT ------- DATE lZr��OL <br /> FILL~ADDRESSTHIS S1DE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> _11444 4.00yWAirt. II 55'S N. . <br /> V4 y4iytP_M&A*-y <br /> WAA <br /> 8 ;C • <br /> Do r v, <br /> fl Z N, C W W Arc. fyj L_ <br /> - <br /> ✓ Sit 4F. �• �_� <br /> ENVIRONMENTAL HEALTH DIVISION FILES Vlw( c-�L <br /> �Il uNDERaRouNb TANK(UST)CLEAN UP SITE(LOP) 0 ROUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> VL OTHER CI..EANUP SITE(NON-LOIS) ❑ FOOD FACILrtY O SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL j ❑ DAIRY ' <br /> HAxARDOUS WASTE GENERATOR o CHICKEN RANCH . 0 PKG TREATMENT PLANT <br /> 14 TIERED PERNInTBD FACiL.nTY d MOTELIHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM lit 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{2091464-4138 or mail to the <br /> address indicated above. <br /> 2. END will notify the applicant If any END files exist. An appointment for review will be confirmed <br /> approAmately 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 far 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 avallabie. <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$89.80 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> G. 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 /> •n nin nor '�"' <br />