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SAN !�UIN C:7E�N�Y =UELIC HE 1�-H 0"s <br /> V;fIRONMENTAL HEAI_.TH DIVISIC <br /> MAR <br /> 1 i 3t34 EAST WEBER AVENUE,THIRD FLOOK <br /> Q STOCKTON CA 95202 <br /> (209) 468-3426 <br /> POBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT- p s3L1SFNESSlAGEAtGY Y�t_f l� LfU �l i/�! r r�' <br /> AdDE1=55 a l &�_I� <br /> FL1O3N U FAGSiiySl[.T � <br /> 1 <br /> e- r <br /> 'e4TATTVE*APPOIN-rmENT DATE 14J l l Da'nLIE <br /> (Plias€ghre T to 40 brx5Jn days fT4m date at appllcatlort sultmiitaf) �€ <br /> ` CHECK 8OXTOEXPEDiTE REQU - TTDQ FF-E-REQLJE T PROCF,S$ED PH 3 SUSINF.SB DAYS <br /> SIGNATURE OF APPLICANT � DATE <br /> FILE ADDRESS <br /> d j <br /> N f t= c� I^ L <br /> D d r <br /> ?I- Mefthomori Lahp4 - J 0 <br /> 'lh 30 <br /> 6 IA)F- J - <br /> ENVIRONMENTAL. HEALTH DIVISION FILESS��2' <br /> ti L l s.{ <br /> UNDERGROUND TANK(uST')CLIP�t+IUP SITE(LOFT) ❑ tfOUSLPIG ALiA`17Ffk1FIN'I' Cl SU �F UQ WAST 1IStY <br /> OTHER CLEANUP SITE(NON-L.CPJ ❑ FOOD FAGfLLTII IIID- 1J�ASTE VEH[Ci£ <br /> UN❑FRGRcuNA TANK(MONITCRINI GIREMOVAL) ❑ 0Or,KENNEL U DAIRY <br /> >C:-iA-4AKQ0t1S WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREAVVIENT PLANT <br /> ❑ TI5REI}PEwAmyi)FACILITY U M0T£L-gi0Y4>_ 13 PUMPER TRUCKNARDCHEM TOILETS <br /> CI TAiT00,13013Y PlEIRGINv ❑ POOL-(SPA LAND USF APPLICATION 3aE3 <br /> C ML-01GAI-WASTE FACILITY ❑ PUBLIGvrATER SYSTJ=m `l�- OTHER(PL.FASE SPVCIFY ABOVE) <br /> 1. List up to ten addresses;in the space above. 5elect the type(s) of files korn tlae fist above by chocking <br /> the approprlato box(es). At least one file type MUST ba selected. Fax to Wg) 464-0138 or mail'to the <br /> address indicated above. <br /> 2. EHD will notify than appficarit it any E»fl files exist An appointment for review will be confirmed <br /> approximately five, buriness 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 /> 1 A fife that is actively being worked on by EHD staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any fila not returned In the same cOnd;tlon as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future-file reviews by the same applicant may r0gUJre a $78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed witli EHD staff. <br /> 6. Applications recaiYed after 3,410}ern will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED TM YES NO REVIEW DATE <br /> FH W 14 <br />