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iw.na.r <br /> SAN J QUIN COUNTYPUBLIC HEALTHORVICES um wu <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> MAY 8 2001 STOCKTON CA 95202 zf <br /> (209) 468-3420 <br /> ENVIRONIMENT IIEAUH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT t-t.11, °V� IC R u� BU INESSIAGENCY � }- �( <br /> ADDRESS 3J I f�11"( 5 CLA S d, .4:7rq- W y CA f c- <br /> PHONE( FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give <br /> 77 to 10 business days from <br /> �^'jdate <br /> (/oofS <br /> f application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87.O�E—REQUE T PROCESSED IN 9 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTS DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> �Strn P ti 1G�11 icy <br /> 35" zee J .w - <br /> in . +e Int <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,,, /// <br /> UNDERGROUND TANK(UST) CLEANUP SITE(LOP) HOUSING ABATEMENT SOLID WWASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) FOOD FACILITY SOLID ASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR CHICKEN RANCH PKG TREATMENT PLANT <br /> f TIERED PERMITTED FACILITY 9 MOTELIHOTEL PUMPER TRUCKIYARD/CHEM TOILETS <br /> TATTOOIBODY PEIRCING '%I-,POOLISPA —" LAND USEAPPLICATION 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 (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 $87.00 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 /> EH 00 14 00/07/00 <br />