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UIN COUNTYPUBLIC HEALTH�VDGES <br /> j NVIRONMENTAL HEALTH DIVISIO / , <br /> 304 EAST WEBER AVENUE,THIRD FLOOR e& S'/ j/� <br /> STOCKTON CA 95202 j <br /> / (209) 4603420 / <br /> PUBLIC <br /> � RECORDS RELEASE APPLICATIO „� �,.� -���_,,i ��� <br /> APPLICANTO nH� CJS BUSINESSIAOENCY ddWil <br /> ADDRESS 837 &6uJ &—OJ- S-tocktO A,, C9//�Iq/s���ls (y v <br /> PHONE / -/OD& FACSIMILE_ 9- 7& / " ///d I <br /> TENTATlVE`APPOINTMrNTDATE It ?OL11 TIME /()'lJ _ <br /> (Please give 7 to 10 burin s days hom date or applimtlon submittal) <br /> 25 <br /> CHECK BOX TO EXPEDITE REQUES 78.00 FEe I-��Rl}EgUEST ROC SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4tC —.. — DATE <br /> FILE ADDRESS O <br /> n <br /> \j IZZ2 It rr r „231t.,�3o1 Is o �3 6 <br /> /e D u <br /> ,.v r I• r r rr ♦ gf. ZZo, unni <br /> fli lull U +6 <br /> N <br /> rr I r r, fr (oyb a3 <br /> in er n <br /> Alfier an e3ci t Zo b/,a zun C� G2 2 zo / <br /> ENVIRONMENTAL HEALTH DIVISION FILES �II <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOUSING APATEMENT ❑ SOLID WASTE FAC "rY <br /> OTHER CLEANUP SITE(NON-LOP) C1 500D FACILITY 11S0Uo WASTE VEHICLE "r <br /> UNDERGROUND TANK JMONITORINGIREMOVAL) '❑, DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIFRE13 PERMI7 FD FACILITY ❑ MOTELlHOTEL ❑ PUMPER 7RUCKr(ARwCHEM TOILLTS <br /> ❑ TATTOOIBODY PEIRCING ❑ POO)JSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILtrY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> T. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected_ Fax to (209)464-0138 or mall to the <br /> address indicated above. <br /> 2. EHD will notify the applicant it any EHD files exist. An appointment for review will be confirmed <br /> approximately rive 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 Tile 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 END staff. <br /> & 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 /> 11H 64 14 Magma <br /> a <br />