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l7 <br />0 <br />�4. , RECD#V�rD� <br />aAly JVHtiIJIN L:UUN I Tj Uk5Lfl; HEALTH SERVICES <br />SEP 0 5 <br />ENVIRONMENTAL HEALTH DIVISION <br />201 <br />304 EAST WEBER AVENUE. THIRD FLOOR ENVIRONM <br />STOCKTON cA 9=2 ENT <br />1209)468-342A PERMIT/SER"Ici <br />PUBLIC RECORDS RELEASE APPLICATION <br />_--- <br />THE, <br />APPLICANT BUSWE331AGENGY <br />ADPREs5 .. .. .. <br />I. <br />PRONE `-' `^�A © FACSIMILE <br />TENTATIVE` APPOMTMENT DATEE u .TIME ir;L•`% <br />(Mew 9W* 7 to 70 b Win ffbh date of aavIc;atl n' aUhwta1) �— <br />! <br />CH!CK' BOX ToEXPEPITLiRRQUEST•43T.00FPC -KEQUESFPROCE$SEq_yl 65iriE YS <br />C�. <br />SIGNATURE OF APPLICANT DATE <br />FILE ADPRE9S HIS SME END' AF SE CNLT <br />PROeRAMEL! UOM SEAKCH <br />IZ <br />n: <br />I <br />I <br />ENVIRONMENTAL HEALTH DIVISION FILE'.$ <br />UNPE:RGROUNP TARK (UST) CLEANUP aITE (LOP) 0 HOUSING ABATEMENT � 60416 WAS 19 PACILITY <br />k N"91%GROUND TANK (M0NRORING/AffM0VAL) In DOG KENNEL O DAIRY <br />HAZARDOUS WASTE GENERATOR D CHICKEN RANCH 13 FRO TREATMENT PLANT. . <br />TIERE13 PliRIAMKO PACIIJ7Y l7 MOTEUHQ7RIL O PUMABR.7RVC)WARD1CNEM TOL_Er6 <br />TATTOD1600Y PEIRCINU M POOL)SPA 0 LA/A USE APPLICA100H UMS I <br />C3 afEWCALWASTE FACILrrf O PUBLICWATBRSYSTEM G 0THfiK(PtU6AI;BwzCIFyABWq Ij <br />1. List up to tan addresses In the space above. Select the type(,`) of files from the list above byoheckirjg <br />the appropriate box(**). At least one Lila type MUST he selected. Fax to (1464At31IGlnalt to tf►a <br />sddross Indirated a02ve. <br />2. EHO will notify the applicantif any EHD flies exist. An appolntmonCfor review will be confirmed <br />approximeteiy five buslnsas days but no later than ton (10) days after rseelpt of application. The filer . <br />will be field for a maximum of fie business days for review. Appointments should be 5chedulad I <br />accardinviy. <br />3. Adrls that is actively being worked on by EHD stall may not bo imdltdlately available for review. A naw <br />application may be submitted when the fila Is available. <br />a. Any flIQ not returned In the same condition as released'will be reorpailiaed by f-HU'staff at lhe.oxpeetae <br />of the applicant. Future.111e reviews by the came applicant may require a $87..00 deposit prier to ravlew. <br />s. "TENTATIVE appointment dates must be confirmed with EHO staff. <br />U. Applications reoaived after 3:00 pm will be procescsd We next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />TIME <br />PHONE FAX INITIALS <br />DATE <br />ffa <br />10 <br />ILTH <br />S <br />WON <br />