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X2003 3 26P CONDCk EARTH TENNOLOMS 11IlaNO . I:' <br /> JrUY JU044LUH11 COUNTY <br /> ENV6tiT1NMENTAL HEALTH DEPARTMEN" <br /> 304 EAST WESER AVENUE,THIRD FLOOR �) <br /> STOCKTON 95202 I L�/� <br /> p g 2003 (203) 468-3-3 420 JIB/.//- <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> jDRESS <br /> PHONE ^(� c� FACSIMILIi �✓ / ( J <br /> TENTATIVE`APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business clays from date of application submittal) • [J <br /> CHECK BOX TO EXPEDITE REQUE -$09.00 FEE—REgUE.f'IROCE3 D IN 3 BUSINESS D/IYS <br /> SIGNATURE OF APPLICANT DATE' /'-7 a G✓ Q'0 <br /> FILE ADDRESS TIDE EW,STAFF USE ONLY <br /> PROC_RAM El EMENTS SEARCH <br /> rUl <br /> D � <br /> ,p}} ENVIRONMENTAL HEALTH DIVISION FILES ; <br /> 1yr(' UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT !;0110 W4STE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY LiOIJU W ASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG K1:NNEL ❑ ❑AIRY <br /> itC7 HAZARDOUS WASTE GENERATOR ❑ CHICIQ N RANCH In L'KG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL'HOTEL ❑ PUMPER TRUCIVYARD/CIIEM TOILLTS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOL/SPA pb LAND US E APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY)---,—.— <br /> 1. 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 te_ .'Ij 404-0138 or mall 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 receipi;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 Mat Is actively being worked on by EHD staff may not be immediately I lval lahle for roview. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the same condition an released will be reorganized by END staff at the expense <br /> of the applicant- Future file reviews by the sCime applicant may require a $fir'-00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be con`Irmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next busine FS day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAILS, JW_ S <br /> =.WED YES NO REVIEW DATE <br />