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SAN Jr WIN COUNTYPUBLIC HEALTH SEP <br /> .4VIRONMENTAL HEALTK DIVISION 6.61 C <br /> / 304 EAST WEBER AVENUE, THIRD FLOOR o ) <br /> (Q STOCKTON CA 95202 <br /> (269)468-3420 <br /> `1 PUBLIC RECORDS RELEASE APPLICATION <br /> APP11CAUT nn�%t-wit- NS4V6��BUSIIIESSIAGENGYE OfJDe'�- /-�,ti=(,,1}NoLo(a!6S <br /> AOURESS.L[�Q�-xy, W&�-T C(w�.E: Svc_ ST()(�Gjb fV t C4 9 5 ZD <br /> PHON=_ FACSIMILE '2 — OT3t7 <br /> TENTATIVE`APPOINTMENT DATE TIM& <br /> (Please give 7Iola buEindas days Dom data ofappltcafi n s rrlttx:) <br /> UAII <br /> © CHECK BOX TO EXPEDITEREQUESTI B 0 7OCT 19 <br /> SIGNATURE OF APPUCAtti - DATE D _ <br /> FILE AbDRESS THIS SIDE EHOSTAFP USO ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> toS 9..�_ S3Fa: O <br /> FT F ST. <br /> / <br /> 2-01ILiLl. _ r <br /> ✓✓ F7_0 v <br /> V <br /> ENVIRONMENTAL HEALTH D1V1510N FILES <br /> ONDCROROUND TANK(UST)CLEANUP SITE(LOP? ❑ HOUSING ABATEMENT X SOLID WASTE FACILITY <br /> X OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SONO WASTE VFMIC" <br /> JIT UNDERGROUND TANK(YONITOKWQgKEMOYAL) 0 DOG,KENNEL pY.OAURY <br /> .5K HAZARDOUS WASTE GPNCRATOR �GHICKRN RANCH D PKG TREATMENT PLANT <br /> t3 TIERED PERMITTED FACILITY O 1AMI-MOTEL ❑ PUMTERTRUGWYAROXIIEMTOILETS <br /> O TATTOOMOOY PFAR[WG 13 POQ"PA ❑ LANOUSEAPPLICATiONSREs <br /> JIf;MEDICALWA37TE FACILITY o PUBLIC WATERSYSTEM ❑ OTHER(PLEASEsPECIFY ABOVE) <br /> 1. List up to ten addressoa In the space above. Select the type(s)of files from the Ilst Acove by[necking <br /> the,appropriate box(es), At least one file type MUST he salaotad. Fax to(309)9L464-013B or to thq <br /> address Indicated„above <br /> 2. EHD will notify the applicant if any EHD Mau 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 Was <br /> Will be held for a maximum of five 4 usinesa days for review. Appointments should be schedulad <br /> accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be immediately avuiloble for review, A new <br /> applicittian may be submitted when the file is avaliable. <br /> 4. Any file not returned in the same condition as relapsed will be reorganized by EHD staff at the expense <br /> of the applicant. Future file review$by the Same applicant may require a$97.00 deposit prior to review. <br /> 5. 'TENTATIVE appOlntmettt dates frust be Confirmed with EHD staff. <br /> 6. Applicatlons MCeiVed after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATk TIME <br /> DATECONFIRMED PHONE FAX INITIALS <br /> REVIEWED RMISIW DATE _ <br /> YES NO ` <br /> TCTTAL P.32 <br />