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Yar • 5 . 2002 5 07P C` '1R EARTH TECHNOLOGIES No•8600 P - 2/4 <br /> /SATE RECEIVED FHA LOG NUMMFR <br /> SAN JOFFAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> rNVIRaNMENTAL HEALTH DIVISION A <br /> b04 EAST WEBER AVENUE,THIRD FLOOR <br /> . 7 4Z <br /> STOCKTON CA 95242 <br /> 02 1"I,ri -ti P f (209) 468-3420 <br /> �HEIC RECORDS RELEASE APPLICATION <br /> APPLICANT t� � �Q1 :P � BUSINESSIAGENCY <br /> ADDRESS 1 � <br /> PHONE FACSIMILE <br /> TENTATIVE`APPOINTMENT DATE Q 'c ` D 2-- .-11ME �l � <br /> �Please glve7 o hush s dayts m date application suhml#Lal} <br /> KongQ CHECK BOX TO EXPEDITE REQ -$87.00 FEE— AtF-all3'Ql1SINESS DAYS <br /> SIGNATURE O1=APPLICANT [DATE <br /> FILE ADDRESS THIS SIDLE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Pel JA tP—C&V_ <br /> 0 11Atte- <br /> 2S Go �9 <br /> 01 <br /> AE2&A�E 'Z9•sa <br /> / ENVIRONMENTAL HEALTH DIVISION FILES <br /> C� NDERGROUND TANK(UST)CLEANUP Sfl'E(LOP) a HOUSING ABATEMENT "OLID WASTE FACILITY <br /> �THER CLEANUP SITE(NON-LOP) 171FOOD FACU-rrY D SOLID WASTE VEHICLEQ-jJNDERGROUND TANK(MONITORINGIREMOVAL) ID DOG KENNEL MDAIRY <br /> 1JOUS WASTE GENERATOR II'CHICKI;N RANCH 0 PKG TREATMENT PLANT <br /> FX TIERED PERmrrT'ED FACILITY ❑ MOTEWHOTEL ❑ PUMPIrR TRUCKIYARDICHEM TOILETS <br /> 0 TATTOOIBODY PEIRCING M POOLISPA - 11 LAND USE APPLICATION SrFES <br /> [ti MEDICAL WASTE FACILITY 11 PUBLIC WATER SYSTEM U 0114ER(PLEASE SPECWYABQVE) <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 (2091_40-01_ 8 or mail to the <br /> address indicates!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 hold 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 /> 41. 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 /> S. *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 />