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DATE AECMV> 0 <br />'fj�I}}] <br />HEALTH iGF-S <br />E.FiU L{]3 NUMEnt k <br />S N JVQUIN COUNTYPUBL(C $I <br />ENVIRONMENTAL. HEALTH DIVISION <br />304 EAST WESER AVENUE, THIRD FLOOR <br />AUG 16 <br />2001 <br />� STOCKTON CA 95202 <br />(209} 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />FA <br />-.-Tz.. .u..j <br />APPLICAN ( N� S�Y1 _BUS INrES&AGENGY <br />ADDRESS <br />PHONE AQ 17 ~110 9G 1fi1"_�! <br />TENTATIVE* APPOINTMENT DATE �i l L{K T11�E 1 <br />(Please give Tf'to 10 bush data of applicatidn7 sutnInal) <br />CHECK BOX TO EJ(PEDITE REgU $79.00 E REQU W E0 IN 3 BUSINESS DAYS <br />SIGNATURE Of" APPLICANT DATE <br />f -- <br />ENVIRONMENTAL HEALTH € IVISION. FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) © HOUSING ABATEMENT O SOLID WASTE F=ACILITY <br />OTHER CLEANUP SITE (NEON -LOP) d FOOD FAGILRY m SOLID WASTE VEHICLE <br />UNDERGROUND TANK jMONrrORING1REMQVAP ❑ DOG KENNEL ❑ 'DAIRY <br />HAZARJ30US WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br />0 TIERED FERNIfTTED FACILITY ❑ MOTELfHOTEL C1 PUMPER TRUCi(fYARi]1GHEd1t TOiI E7g <br />F-3 TATTOOMODY FORCING ZI POOUSPA D LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY 0 PUUWC WATER SYSTEM i7 OTHER tPLEASE SPECIFY ABOVE) <br />1. list up to ton addresses in the space above. Select the types) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST he selected. Fax t 209 464-013A or mail to,t <br />address indicated above. <br />2. EHD will notify the applicant if any EHD Tiles exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of appllcation. 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 Elia staff may not ba Ilmmediately available for review, A new <br />application may be submitted when the file is available. <br />d. Any fila not returned in the same condition as released will be reorganlzed by EHD staff at the expense <br />of the applicant. Future file reviews by the salve applicant may require a $78.00 deposit prior to review. <br />5. *TENTATIVE appointment dates must be confirMed with EHD staff. <br />6. AAplicatlons received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX 1NITtALS <br />REVIEWED YES NO REVIEW DATE <br />