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THU 13:02 FAX 925 253 4985 - TREADWELL & ROLLO liJooI <br /> v t 11 SAN JOAQUIN.0 Uho 'TYPUSLIC HEALTH SERVICES ENo tpp hpiy lEq <br /> ENVIRONMENTAL HEALTH DIVISION <br /> COOS 304 EAST WEBER AVENUE,THIRD FLOOk <br /> _ I <br /> JT HEALTH STOCKTON CA 95202 1 . <br /> /SERVICES (209)463-3420 Att�l I „ (za11�8-32. <br /> 4 z <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 4+PLICANT �rirc � !M G - 9"--- --- <br /> ��1I .Ty1 BUs1NESs/AGENCY� i' _ <br /> ADDRESS 1 I 1c" I Or �• •1- randr2`�CIE�—_445(0 -_ <br /> 4. . � �e <br /> PNONE__9L3-L5,3-y9By X F CS MV - <br /> �114, <br /> u — <br /> pNT GATE U <br /> TENTATIVE`APPOINTM �j TIME <br /> (Pleaza plus 710 to businocs days from UAW o1 appllcatlon subs nlUal) <br /> CHECK BOX TO EXPEDITE REQUEST 9.00 FEE- EST PRO SED IN 3 BU IN S IAYS <br /> i I <br /> SIGNATURE OF AI'ptJCANT ATI, <br /> FILG ADDRLSs THIS rit?E END STAFF USE ONLY <br /> PROGRAM EI.CMIEiNTS SEAnPH O <br /> `f Wet r c�� <br /> W est W <br /> `18b Tfac - <br /> 4 <br /> v 4 W,-t& - <br /> `i7 we-Si Q _ 1 <br /> 11 2315 7ru 'SnAe\I&("rA <br /> pa <br /> i ion I.A. rn..�t <br /> rd — -- -- N <br /> Line kad <br /> rAg. _air J . - <br /> ENVIRONMENTAL HEALTH DIVISION FILE. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP( 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0-SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(NIONITORINGMMOVAL). ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH . 0 PILO THEAI'MENT PLANT <br /> TIERED PERMITrED FACILITY 0 MOTEl1H0YEL 0 PIIMPERTIt11C:KA'ARDfi:liEMTOp-ETS <br /> O TATTOOIRODY PEIRCtNo O POOLISPA ❑ UJWO USE APPLICATION SITES _ <br /> O MEDICAL WASTE FACILITY } 0 PUBLIC WATER SYSTEM ❑ O'rHEk(PLItASE SPECIFY ABOVE) . <br /> 1. Ust up to ton addresses In the space abovo. Select the type(s) of fibs from tho list above by checking <br /> the appropriate box(es). At least one lila type MUST be selected. FoX I.0 209 464-0138 or mail to(he <br /> address indicated above. <br /> 2. EHDwill notify the applicant If any EHD riles exist. An appointment I'or review will be confirmed <br /> approXlmately five business days but no later than ten(10) days after receipt of applicdtion. The files <br /> will be held for a maximum of five business days for review. Appolntm ants should be schadulnd <br /> accordingly. <br /> 3. A file that Js actively being worked on by EHO Staff may not be immediately available for review. A new <br /> application may be submitted when tho file is available. <br /> 4. Any file not returned ih the same condition as reloased will be reorgunized by EHD staff at the expense <br /> Of the applicant. Future rile reviews by the same applicant may require a 589.00 deposit prior(o 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 burinasrday. <br /> CONFIRMED APPOINTMENT DATE. TIME ` <br /> DATE CONFIRMED PHONE FAX .. INITIALS <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> -- �" ' ••"••+•' �•-"•^-•^••�••^ Ot-Tn1aO Tb:oT 7007I7T/TT <br />