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wHre .;JAQUIN CUUN"i YPUBLIC HEALTH SER <br /> ES <br /> i Ei�RONMI=NTAL HEALTH DIVISION <br /> 3w ST WEBER AVENUE,THIRD FLOOR <br /> C' STOCKTON CA 95202 _7 . <br /> (209)465-3420 <br /> - I -' PUBLIC PECORDS RELEASE APPLICATION <br /> J. iPPL1ClUy7 (`{'� 1 6USINESSIAGENCY � 1T. E�.Q7r "�', d� IOJCi�. '�JpS"`oylCQs <br /> ADDRESS j L&E -DrZr, $�Z C$nt�rp l <br /> nuiftA <br /> PHONE t 1 �--55` ZJ7 FACSIMILE [�1 . <br /> ;TENTATIVE"APPOINTMENT OAiTE t�' I- O TIME ( Q ; Q <br /> {Please 9lve 7-.01 o bu:inCSS nays from nate of application su4mittat) <br /> 1 + , <br /> 0 C?lEcgt Dox TO EXPEDITE REQUEST-SW-00 FEE-REQUEST PRO(I!SSED IN 3 BUSINESS DAYS <br /> �SIGNATU12E OF APPLICANT (Jr <br /> DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARGN O <br /> C7 c- k A 4t5-17. 2 <br /> i womb <br /> ------------------- <br /> % nn rrnn � <br /> i <br /> L <br /> EN Iy1RONMENTAL HEALTH DIVISION FILES OCT 2 9 2001 <br /> ' UNDERGR OUNOTANK(UST)CLEMUP SITE(Lop) p HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> Ja OTHER gLEANUP SITE(NON-LOP) M FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUNO TANK(MONITORINGIREMOVAL) ❑ DOG KENNA. O DAIRY <br /> N HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> 0 TIERED[?E DY PED FACILITY 0 MOTCIJHOTEL 0 PUMPER TRUWOYARD/CHEM TOILETS <br /> 0 MEDICTATT0IJi WASTE <br /> PEIRGNG 0 POOIJSPA 13 LAND USE APPLICATION SITES <br /> a MEDICAU WASTE FACaifif <br /> I ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABDVE) <br /> 1. �ist up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> Wahe appropriate box(es). At least one rile type MUST be selected. Festa(209)464-0138 or mail to the <br /> ddress 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 pays but no later than ten (10)days afterreceipt of application. The files <br /> tdilt be held for a maximum of five business days for review. Appointments should be Scheduled <br /> accordingly. <br /> 3. file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> pplication may be submitted when the file is available. <br /> 4. Any file not returned in the Same condition as released will be reorganized by EHD staff at the expense <br /> df the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 7ENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. i RpplicationS received sifter$:00 pm will be processed the next business day. <br /> ' <br /> I <br /> CaNFIRIYIEp APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> j INITIALS <br /> REVIEWEI) yEg <br /> l'.H w ++ aeaano REVIEW DATE ' <br /> TOTRL P.H2 <br />