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EN9 LG:NLYJi�¢Jy <br /> „ICRcc� n SAN „NQUIN COUNTYPUBLIC HEALTH ScRVICES <br /> ENVIRONMENTAL HEALTH DIVISION r7 !1 <br /> 304 EASo <br /> T WEBER AVENUE,THIRD FLOOR (� �f <br /> U STOCKTON CA 95202 <br /> (209)46a-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 3us1NEssjADENGY � ovC�or L-c-zn �e-'-kl"-o112 <br /> APPLGANT M�'-'r i�- 19 S 26 <br /> ADDRESS 156 Fr�v�k Wast Giycl¢ {R }ocic Sova <br /> PHONE <br /> 2041 2-3�ogIeP FACSMI-E 2a�l - 23'� _ oS38 <br /> TENTATIVE'APPOINTMENTASAP TIME <br /> (please"y1vD 7 in t0 hus{nNsS ddya.DATE from data of�PPHcalion svbrrJttal) <br /> ' <br /> Q SINE33AYS <br /> XEDIEREQUET-$4 .0FE-RECUE PR ESEDIN3U <br /> C1iECKgqXTOE11 g JYI <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILH ADDRESS THIS SInE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> S38 �• Glno-ww+t � � <br /> dotFUN <br /> �3l i^. t�iwsv <br /> sly �. W.•a''_1w� N <br /> too-4r,. W4 N <br /> W R. L.Y t4 r <br /> bl WR^�9L.Y b0i J",4 <br /> 7t1 Wt.bar <br /> io'4 t-A, y zr- , k, <br /> 126 I.A . PK.ayiC"V% <br /> 11 4 K. V+-wt s Lv�S� � ENVIRONMENTAL 14EALTH DIVISION FILES <br /> SC C�Houaw ABATEMENT ❑ SOL1D WASTE FACiI..TY <br /> 6 THER CLEANUP <br /> TANK iNO CLEANUP srrE(LOWI. ❑ FOOD FACILITY ❑ SOLID WASTE YEteC LE <br /> ;- THER GLFANOP SITE(NON-LOP1 \CCC ❑ DOG KENNEL ❑ DAIRY <br /> LY�NDERGROUND TANK WON1TORINGIREMOYAI) _ 4 CHICiCLiM RANCH n PKG TREATMENT PLANT <br /> Ln'HAZARDOUsWASTE GENERATOR ❑ MOTaMOTEL b PUMPER TRUCMARDICHEM TOILETS <br /> ❑ T(ERED PERINTTED FACILITY ❑ PdOOSPA — , ❑ LAND USE APPIJCATTON SITES <br /> ❑,,FATTOCIRODY PEIRCING ❑ PUHLC WATER SYSTEM Cl OTHER(PLEASE SPECIFY ABOVE), <br /> C.t MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file typo MUST be selected. Fax to (20914M.0138 or mail to# e <br /> address indicat above, <br /> 2. EHD will notify the applicant if any EHD files exist An appointment for review will he confirmed <br /> approximately be held for a Maximubusiness <br /> Offive business ays obut no later than r review. Appointmentsn(10�days after pt of should ibe ached n. The <br /> edfiies <br /> accordingly. <br /> 3. A file that is actively being worked an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the fila is 2vailabie- <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />