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295 <br /> gFROM <br /> usa � <br /> SERVICES #� <br /> ENVIRONMENTAL .` , 6 . <br /> 9 T WESER AVENUE,THIRD STOCKTON CA 95202 ENVIRONMENTHEALTH <br /> (209)468-3420 PER <br /> PUBUC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ad I TeC E I� <br /> ADDRESS <br /> PHONETENTATIVE*APPOINTMENT DATE <br /> ELS <br /> (Please tv 7 t 3 Taia caa rr�iaa al <br /> IA-CHECK BOX TO EXPEDITEREQUEST aL? T PFtCCt)3 <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> aL A R sT1416 SIDEO STAFF V ONLY <br /> pROGRAM SLF_MENTS <br /> VNVIRONMENTAL HEALTH I NISI IL E <br /> uNvERGROUND T (UST)CLEANUP SITE(LOP) USING A* AT SOUB WASTE ACI I <br /> TY <br /> TOER CLEANUP SITE(NON-LOP) 0 Foot)FACILITY 0 soLin WASTE VEHICLE <br /> a a Tp#ft C14ICKER Caa PKC EAT PLANT <br /> TIERED P ITTeD FACT B T as CI a UC as a TOILETS <br /> TATF001800Y PEIRCINGPO0I 1 PA 0 LANDU39 APPLICATION <br /> SIMS <br /> MEDICAL WASTE FACILITYs PUBLIC WATER SYSTEMOTHER(PLEASE SPECIFY AROVE) <br /> 1 List cap to ten addresses In the space above. Select the p Of files from the list above by checking <br /> the r prl t+ bta toast one file type MUST be solected. Eax to 209 r mail tohe <br /> 2. aaddes <br /> 'Ta dtd lr <br /> EH rllt rarattfy the <br /> g pliC t If Tay`E tl Blas at i t� appointment for review will b confirmed <br /> p inn y i b on days;but as later than teas 9 days after r C t f application. The i <br /> wll h d for maxim m caf five business for review. Appointmentsshould b h dul l <br /> accordingly. <br /> file that Is ootively being worked on by EHO staff may not be Immediately available for review 'Anew <br /> application may be submitted when the file it,available., <br /> Any file not retumed in the some Condition as released will be reorganized by END staff at the expense <br /> f the applicant. Future file reviews by the Sage applicant may require 99.00 deposit prig to review. <br /> 5. *TENTATIVE appointment dates must be Confirmedwith EHD staff. <br /> pp i' tias rocolved after 3:00 per will bo processed the next brashness day. <br /> CONFIRMED APPOINTMENT DATETIME <br /> REVIEWEDDATE CONFIRMED PHONE FAX INITIAL$ <br /> YES NO REVIEW DATE <br />