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SAN J(`4" QUIN COUNTYPIUlrilr..iC H1 ALI i-i �' ' ".'vii:t=:► <br /> JVIRONMENTAL HEALTH DIVISh <br /> RUSH304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 1U • Ae.._ A2J BUSINESSIAGENCY (L"ACed <br /> ADaftESS I <br /> `7 t� /If W/ so d �C 0r 9 Y.-Ros_ <br /> PHONE U'Q FACSIMILE <br /> �C) C <br /> TENTATIVE*APPOINTMENT DATE � TIME <br /> (Please give 7 to 10 b siness days from date of application submittal) 00 <br /> CHECK BOX TO EXPEDITE REQU T-$78.00 FEE—REQ T RO ESSED IN 3 BUSINESS DAYS Z N <br /> (((SIGNATURE Ql APPLICANT DATE o <br /> 1 FILE ADDRESS <br /> V `� •�• ) � Cmc J C. <br /> v! . q&D <br /> c; Ccs <br /> 1411.0 r � o <br /> 14 <br /> jo <br /> £ z 3O 3 <br /> 575— It t a3u1 <br /> ? Ltd <br /> • pro . n6 l»i Les ... l>r tv'v ra ur" D8 07Y► tka�# "g SA .Ro7+ .J'v3 '' <br /> ENVIRONMENTAL H4ALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE{NON-LOP} ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIRENOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> t:J TIERED PERMITTED FACILITY U MOTELIHOTEL ❑ PUMPER TRUCKlYARDICHEM TOILETS <br /> © TATTOOIBODY PEIRCING Q POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM OTHER jPLsASE SPECIFY AI3QVfL <br /> 1. List up to ten addre$seS In the Space above. Select the type(s)of files from the list 4bove by checking <br /> the appropriate box(es), At least one file type MUST be selected. Fax to 209 4154-0138 or mail to the <br /> address indicated 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 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 EHD 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 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$78.00 deposit prior to review. <br /> S. `TENTATIVE appointment dates must he confirmed with EHD staff. <br /> 6. Applications received after 3:00 prn will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED ---__-_-- PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 OV05JO9 <br />