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,—W:�aOIZUUZ tU:58 FAX W002/002 <br /> oAT6 It9COWD <br /> EHD LOC NUMBER <br /> 1P SAN .�„wAQIJIN COUNTYPUBLIC HEALTH k,..ZVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> /yl�q�cC,-— BUSINESSIAGENCY �''� e/�-�, -- ,: _:,•1y <br /> ADDRESS g�--"s67 <br /> ALONE — /-5' S FACSIMILE � � a,5 2 t <br /> TENTATIVE'APPOINTMENT DATE 1�/ Qom_` TIME r� -'ill <br /> (Please W7tolo <br /> austtr to of app on subm[tsal) 1 ,1NT HRALTF <br /> PERMIT/SERVICES <br /> 13 CHECK BOX TO EXPEDITE REQUEST- REQU T PI7 D IN 9U5lNES5 DAYS <br /> SIGNATURE OF APPLICANT _. � DATE /—' - <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> coemer' or- Pl•orn;,c Tb-i..a n Ca� .eee!c <br /> APN-za ::XAI-- IQ —Al b6ve Rave /►7ktifrew C�4 - <br /> rp�1c E n /399 yon^+%fc 4..e.. a I`b-lam. <br /> CA <br /> Arco -4 p 1711- <br /> ENVIRONMENTAL <br /> 71 ENVIRONMENTAL HEALTH DIVISION FILES <br /> �NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT CI SOLID WASTE FACILITY <br /> UTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCIC/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING E1•POOLlSpA D LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILnY ❑ PUSLIC WATER SYSTEM 0 OTHER(PLEASE SPECwY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to!2091464.0138 or mail to the <br /> addr-o"indicated above. <br /> 2. END will notify the applicant if any EHD files 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 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. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganixed'by EH12 staff at the expense <br /> of the applicant, Future flle 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 /> 6. 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 /> REVIEWED YES NO REV(EW DATE <br /> CH 60 14 04101100 <br />