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P.ie Aec vw twv LW XUYGll1 <br /> AN . AQWN COUNTYPUBLIC HEALTH SL ANCES _ �� , <br /> R ENVIRONMENTAL HEALTH DIVISION `7 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 93202 <br /> " (209) 468-3420 [-- %•'i <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> rAPPLICANT5fwlril ,( WD�SNfh 81)51NlSSlAGENCY AFeK i✓lIV(rrOIGk 6✓1JI �' 09 <br /> ADDRESS y}7l{i ( / C- 44 W& FRT�[.,S YT 17s 24EM m. <br /> PHONE <br /> TENTATIVE'APPOINTMENT DATE /21/OD TIME A.✓11 <br /> (Plcme vire 7 to 10 bus es rays tun date of aw1kation submittal) — <br /> CHECK BOX TO EXP EDRE REQUEST.597X0 FEE-REQUEST PROCE$$ED W 1 BUSINESS DAYS �y <br /> SIGNATURt OF APPLICANT(- DATE <br /> FILE ADDRESS TMS SIDE EMD STAFF USE ONLY <br /> PROGRAM EISMENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNUERGROUNDTANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT - ❑ SOLID WASTE FACILITY <br /> b OTHER CLEANUP SITE INON.LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNOERGROUND TANK(MONITORN(;IREMOVAL) ❑ OO6 KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GENERATOR C CHICKEN RANCH t7 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACIUTY - ❑ MOTELMOTEL Q PUMP"TRUCWYARDIICHEM TOILETS <br /> ❑ TATTOMOOT PKIRCING ❑ POOU3PA ❑ LAND USE APPLICATION SITES <br /> b IaEDICAL WASTE FACILn-Y -❑ PUBLIC WATER 3Y3TEM ❑ OTHER(PLEASE Sr!CIFY ABOVE{ <br /> . List up to ten addresbes 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 type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address Indicat��boveIndicat��bove, <br /> 2. EHD will notify the applicant if any END Ales exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application_ The Hies <br /> will be held for a maximum of five business days for review_ Appointments should be scheduled <br /> accordingly. <br /> S. A file that is actively being worked on by END staff may not be immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4_ Any file not returned in the same condition as released will be reorganized by END staff at the expense <br /> j of the applicant. Future file revlaws by the same applicant may,require a$87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 9. Applications received after 3:00 pre will be processed the next business day. <br /> CONFIRMED APPOINT MHNT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL P,02 <br />