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JX141 ,4JAWL)iN 6UUNIYPUSLIC HEALTH ';;I_RVICES <br /> W ��uUUNVIRONMENTAL HEALTH D1VIS.J <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> JUL 2 5 2000 (los) 468.3420 i <br /> PUBLIC RECORDS RELEASE APPLICATION " <br /> APPR ' II '' �J BUSINESSfAGENCY advanced rm0&V!�'YJ/'&eD fa/,�'jx <br /> ADDRESS 05 (,U/(s CA •sa175' <br /> PHONE o7D - QD FACS) IILLLE <br /> TENTATIVE'APPOINTMENT DATE U`v ei'( DD TIME <br /> (Please give 7 to 10 business ays from date of appiicatian submittal) <br /> CHECK BOX TO EXPEDITE REQU 70.00 FEE-REQU PROJESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT Ur DATE <br /> FILE ADDRESS <br /> OF <br /> IV A <br /> l s 2 0 4 3�) <br /> S � <br /> r tr .ZL- S' a O <br /> 8 <br /> ENVIRONMENTAL HEALTH DIVISION FILES A� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY JUL 26 <br /> ?JLl <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AXARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUCKJYARDICHEM TOILETS <br /> TATTOO/BODY PEIRCING �" � \ ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY-I LItQy�I sp�, Cl PUBLIC WATER SYSTEM 11 OTHER(PLEASE SPECIFY ABOVE) <br /> ine1. List up to ten addresses acA above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). Al least one file type MUST be selected. Fax to (209) 464-0138 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 appiicatlon. 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 /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> B. Applications received after 3:00 pm 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 /> 91 go u aln o <br />