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ALIG-26-2002 15:47 MONTGOMERY WATSON a 925 975 3412 P.01/01 <br /> v SA IOAQU1N COUNTYPU13LIC HEALi, SERVIC <br /> ENVIRONMENTAL HEALTH DIVISION �! <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)466-3420 <br /> PUBLIC RECORDS RELEASE APPLICATIO <br /> APPLICANT,yO V,J 1 I IFi)C '5My � S AGENCY PAwDJ <br /> ADORESS LJL O vA Gv,\ tc. ,�jOl�.-,G G <br /> PHONE (FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE 5 OZ TIME Z=aa �ERMIT/SERVICESrH <br /> r-1 (Please Alva 71010 hays f dalppllmtto sutvnitlal) <br /> u CHECK BOX TO EXPEDITE REQU _R 00 <br /> UE f BUS ESS DAYS <br /> SIGNATURE OF APPLICANT DATE2. <br /> 8 6 v <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> Ny�A� <br /> PROGRAM ELEMENTS SEARCH <br /> D Mt IOVI 0Y1 - to <br /> �I D -� v <br /> b0 IN <br /> (o <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �Z UNDERGROUND TANK(UST)CLEARUP SITE(LOP) ❑ HOUSING ABATEMENT 'M SOLID WASTE FACILITY <br /> Pr OTHER CLEANUP SITE(HON.LOP) ❑ FOOD FACILITY 97 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrromcAIEMOVAL) ❑ DOG KEYNEL 4 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH :Sa PKG TREATMENT PLANT <br /> 19'TIERED PERMITTED FACILITY O MOTEL/HOTEL ') PUMPER TRUCKrYAR01CHEM TOILETS <br /> ❑ TATToomoaY PEIRCING t7 POOLISPA ;b LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY �V 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. <br /> END will notify the appl cant If any END 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 maxiniUM Of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively b4ing worked On by END 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 lei the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. FutuO file reviews by the same applicant may require a 569.00 deposit prior to review. <br /> 5. 'TEI4TATIVE appointrhont dates must be confirmed with END 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 /> oC\„c,e,Cq VCO �,n DC\IIG111/r1A7C <br /> TOTAL P.01 <br />