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_._---- <br />Ul/L8/UU FK1 lU:4U C.\.\ UUZ/U.' <br />G_-"----' [11-^-7-20W 10: 16Aa l FROM c,o tz wan <br />- SAN fAAOIJI N COUNTY IRI Ir i-IFGI TW RFRV 'FS C <br />GNIVIRoMMFNTAI HEALTH DIMS ON <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209)466-3420 mmtva <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT 7PQ ✓1 CDDK BUSINFSS/AGENCY <br />S pfd rn <br />ADDRESS _7'7 4WwrnG_n,rK <74' /Iivvnn 9?/�� <br />o'jp ti�a- jd7 <br />PHONE CSG 7J � I I� � � Sd FACSIMILE <br />EW <br />TENTATIVE' APPOINTMENT PATE �'I TIME <br />(Plea,@ givo 7 to 10 business days trom Cate of apDll�tlon su6miUal) FEB 3 P000 <br />CHECK BOX TO EXPEDITE REOUEST -578. FF_E - R UFST PROCF3SED IN T RUSINESS DAYS O _ Oe <br />DATE <br />SIGNATURE OF APPLICANT �-�� 7 af <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (USN) CLEANUP 517E (LOP) <br />❑ HOUSING ABATEMENT ❑ SCUD WASTE FACILITY <br />1-10 ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br />OTHER CLEANUP SITE (NON -LOP) ❑ DAIRY <br />❑ UNDERGROUND TANK LNERATRINGIREMOVAU ❑ CHI KENNEL ❑ PKG TREATMENT PLANT <br />❑ HAZARDOl1W WASTE GENERATOR O MOTELIKOTELCKEN ❑ PUMPER TRUCKIYAROrc"E4r. TOILETS <br />r TIERED PERMITTED FACILITY ❑ MOTEUHOYEL ❑ LAND USE APPLICATION SITES <br />C1TATTOO;BODY PEIRCING 13 POOUSPA ❑ OTHER (PLEASE SPECIFY ABOVE) <br />❑ MEDICAL WASTE FACILITY in PUBUC WATER SYSTEM <br />1. List up to ten addresses in the spare above. Select the types) of fciles from tRX to he list4138 orbmaihto theg <br />Lhe appropriate boz(es). At least one flle type MUST be selected. <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. Appolntments 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 />5, '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 />FCONFIRMIEDAPPOINTMENT DATE TIME <br />RATE CONFIRMED <br />PHONE FAX INITIALS <br />REVIEWEQ YES NO REVIEW DATE <br />ee o t. omsno TOTAL P.02 <br />