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1C-41-17 t- L C.K. 1. �RDl <br /> J7Yf"1 FM�r'I <br /> -�' onrE r�crr�o Ill 14153821856 P.02 <br /> asoa <br /> SAN QU{N CO(lPfTYPUBLIG HEALTH &V10ES <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> \ i J STOCKTON CA 95202 <br /> �^J (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION g „ J <br /> APPLICANT-7P6—VL— 4-11„_,., DUSMESSlAGENCY—CJ�Jt P—z,,, '<.. . <br /> —.41 Lr1C, <br /> ADDRESS �3 �1(�.l'Tp-i_ '1'-j(?< , �)� (00 Ing a <br /> PHONE FACSIMILE. <br /> TENTATIVE*A powTMFJ(T DATE IZ-30' TINE <br /> (PIaase Ilve'7 to t0 Oysmes5 days front date o(yw1kallon submittal) <br /> XCHECK BOX TO EXPEDITE REQUEST•578,04 F REQUEST PROCESSED N 9 BUSINESS DAYS _ <br /> SIGNATURE OF APPLICANT _ ( [ DATE _ <br /> FILEADDRE S <br /> ��� v� VvL.C., b <br /> V <br /> 7ti <br /> 2 O ESf <br /> 17- <br /> -14 P� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> XUND£RGROUND TANK(UST)CLEANUP SRTE(LOP) ❑ HOUSING ARATENFNT r] SOLID WASTE FACFLfTY <br /> j� <br /> OTHER CLEANUP SITE(NON4")WG/ Cl FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORRE6foVAL) O DOG KENNEL t7 DAIRY <br /> HAZARDOUS WASTE GENERATOR D CHICKEN RANCH O pKG TREATMENT PLANT <br /> ❑ TIERED SODYPERM TERI;ING fLY ❑ MOTEIMOTEL ❑ PUMPER TRUCK/YARDICHEW TDILETS <br /> ❑ MEDICAL <br /> WAST F CIU ❑ POOLrSPA ❑ LAND USE APPLICATIDN SITES <br /> [] MEDICAL WABTE FACIDTY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOvE7 <br /> I• List up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> the appropriata box(es). At least one file type MUST be selected- Fax to 09) 464-0138 or mail to the <br /> __if eels iLidicated above <br /> 2. EHD will notify the applicant if any EHD files exlst An appointment for review will be confirmed <br /> approximatP)y five business days but no tater 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 /> 3_ A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the name AAndiUan as released will be reorganized by EHD taff at the"pen se s <br /> Of the applicant Future file reviews by the same appliCant may require a$78.00 deposit prior to review. <br /> S. 'TENTATIVE appOintnent dates must ho confirmed whi, EHD staff. <br /> 6. Applications recelved after 3:00 Pm will be Processed the next business day. <br /> 14 B lyA�r <9.sK� <br /> uso,a <br /> �2ch <br /> VL-Q-c� CQu Cx. TOWL. P.02 <br />