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SIGN (.1UINCuiJIV!-YPUBLiCHE <br /> �� gi_iH vl�lrs <br /> U. <br /> NViRONMENTgL HEALTH pIV1Si� <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> N0V 17 2000 STOCKTON CA 95202 <br /> FNi HEALTH (2D9) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ppononl1 I <br /> B1PAL7CANTL �..OI�.VIA) J�'A7� _808 INESSIAGENCY J&4110ACP01 �p&Lj1ky6mlQn <br /> ADDRESSL.(/JII rSO C CAI Saw [I SSS <br /> PHONE a'O - (/ FACSIMILE a `!7 V6 '7 -///,P <br /> TENTATIVE'APPOINTMENT DATE -�� <br /> TIME <br /> (PI•ase give 7 eo f 0 flusmess days from date of application suMnittap� O <br /> L3 CHECK BOX TO EXPEDITE REQUEST-M7EE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT \V Q 1 <br /> 00 � DATE <br /> FILE ADDRESS <br /> I;? �1 70 <br /> S G .3S•a.G ��- <br /> _�.3-re-r <br /> 35L7 C-ba 95 0 GID <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UOTHER NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMESITE(NON-LOP) NT ❑ SOLID WASTE FACILITY <br /> 0 FOOD❑ UNDERGROUND CLEANUP SOLIDANK (MONITORINGIREMOVALI ❑ DOG KENNIEm <br /> ❑SOLID WASTE VEHICLE <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ DAIRY <br /> ❑ TIERED PERMITTED FACILITY ❑ CHICKEN RANCH ❑ PKC TREATMENT PLANT <br /> ❑ TATTOO/BODY PEIRCWG ❑ MOTELIHOTEL ❑ PUMPERTRUCKIYARDICHEM TOILETS <br /> ❑ MEDICAL WASTE FACIUFY ❑ POC"PA ❑ LAND USE APPLICATION SITES <br /> ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVC) <br /> t• List up to ten addresses in the space above. Select the types) of files from thelis[above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 454-0738 or mail to the <br /> address indicated above <br /> 2• EHD will notify the applicant if any E40 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 flies <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 /> 6• 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 /> e.+ wu ' r) <br />