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SAN 4QUIN COUNTYPUBLIC HEALTi-RVICES tNu WU r+Urf,utK ENVIRONMENTAL HEALTH DIVISION 304 EAST WESER AVENUE, THIRD FLOOR. STOCKTON CA 95202 (209) 468-3420 PUBLIC RECORDS RELEASE APPLICATION APALICAAtTV BUSINESSIAGENCY ��t-TAS t�1 V t2r� yrF p� S7�IT..gNT ADDRESS C,4mp PHOKE S FACSIAULE N;T TENTATIVE*APPOINTEnDATE t/I p-15-dO TIME fd •�iM t (PlOase give 7 to 1,0 bLIS lnass days from da:r+ of applicailon 8uhmittal} CHECK SOX TO EXPEDITE REQU T - *7788.00 FEE - R VEST PROCESSED 1N 3 BUSINESS DAYS. SIGNATURE OF APPLICANT DATE 6-0- 00 ENVIRONMENTAL HEALTH DIVISION FILES W UNDERGROUND TANK (UST) CLEANUP SITE (LOP) l3 HOUSING AUATEAIENT D SOLID wA5TE FACILITY D OTHER CLEANUP SITE (NON -LOP) G FOOD FACILITY Cl SOUL) WASTE VEHICLE UNDERGROUND TANK (MON n-UFJNGJREMOVAL) 0 DOG KENNEL ❑ DAIRY ID HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH U PKG TREATMeNT PLANT ID TIERED PERMITTED FAACIUTY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILET'S b TATTOGISODY PEIRCING In P00USPA ❑ LAND USE APPLiCA7" SITE$ O MEDICAL WASTE FACILITY ❑ PU9UC WATER SYSTEM ❑ OTHER (PLEASE SPEgFY ABOVE) 1- List up to ten addresses•In the space above. Select the types) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to f2091 464-0138 or matt to the addres- indlGated above 2. EHD will notify the appllcarlt if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The fifes Will be held for a rnaximutn of five business days for review. Appointments should be sahcduled accordingly. 3. A file that is actively being workad on by EHD staff may not be immediately avallablo for review. A new application may be submitted when the file is avallable. �• Any file not returned in the same condition as released will be reorganlzed by EHD staff at the expense Of the applicant. Future fife reviews by the same applicant may require a $78.00 deposit prior to review. �• 'TENTATIVE appotntment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next buslness day- �ONFIRMED APPOINTMENT DATE TIME 4DATE CONFIRMED PHONE FAX INCI'IALS �^ VIEWED YES NO REVIEW PAYE L1� o0 74 7D TCITAL P. 01 THIS SIDE "D $TAVF Ui;F- ONLY.. ENVIRONMENTAL HEALTH DIVISION FILES W UNDERGROUND TANK (UST) CLEANUP SITE (LOP) l3 HOUSING AUATEAIENT D SOLID wA5TE FACILITY D OTHER CLEANUP SITE (NON -LOP) G FOOD FACILITY Cl SOUL) WASTE VEHICLE UNDERGROUND TANK (MON n-UFJNGJREMOVAL) 0 DOG KENNEL ❑ DAIRY ID HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH U PKG TREATMeNT PLANT ID TIERED PERMITTED FAACIUTY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARD/CHEM TOILET'S b TATTOGISODY PEIRCING In P00USPA ❑ LAND USE APPLiCA7" SITE$ O MEDICAL WASTE FACILITY ❑ PU9UC WATER SYSTEM ❑ OTHER (PLEASE SPEgFY ABOVE) 1- List up to ten addresses•In the space above. Select the types) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to f2091 464-0138 or matt to the addres- indlGated above 2. EHD will notify the appllcarlt if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The fifes Will be held for a rnaximutn of five business days for review. Appointments should be sahcduled accordingly. 3. A file that is actively being workad on by EHD staff may not be immediately avallablo for review. A new application may be submitted when the file is avallable. �• Any file not returned in the same condition as released will be reorganlzed by EHD staff at the expense Of the applicant. Future fife reviews by the same applicant may require a $78.00 deposit prior to review. �• 'TENTATIVE appotntment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next buslness day- �ONFIRMED APPOINTMENT DATE TIME 4DATE CONFIRMED PHONE FAX INCI'IALS �^ VIEWED YES NO REVIEW PAYE L1� o0 74 7D TCITAL P. 01