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J."111 "V.M'UCU iI'A. 1IrIUOLJ', i]T...fiE„I! 4 VL-i-.', A <br /> ENVIRONMENTAL HEA>!Tii.D(Vl wN. <br /> 304 EAST WESER AVENUE,'THIRD FL <br /> S70CKTON CA 95202 <br /> (209) 68-3420 11 <br /> , <br /> PVL1C RECORDS RE .EASE]APP'LICATt ]N ' <br /> APPUCANT it {Q., 11WINESWAGENCY Gd- � � _1CJt lfb� 1 <br /> { <br /> ADDRESS ..& 0 <br /> ,��� I1f�,� <br /> ` zYlFAC91MiLL,�ve J � - �O / 1" /!l,f� .� <br /> j PH1QNE <br /> i TI`N 1 ATIV>r*ApPolrrrn�InNr r5a7� ^` ti >> -nweF� vii <br /> (Please give T to 90 busittess days from date of applEt2tIon su6mltta1) <br />` CHECK BOX TO F-XPEI]RRE"1;0 ST 00 FEE QUEST PItOC>;SSr±e7 leK 3 813S1tJ1=S5 UAIfS <br /> III <br /> I SIGNATURE OF APPLICANT l]ATEZ <br /> ii <br /> FI1F�A!]lyi2ES: �+I <br /> 3.5.a(� <br /> i, <br /> Ir <br /> ENVIRONMENTAI-HEALTH DIVISION FILES <br /> UNRERGROUND TANI4{IIS7n CLEANUP Sr=-(LOP) 4 IIOUGING ABA71=MINT;,' 'Q 5OUQ WASTE FACILJTY <br /> prtHER CLEANUP SITE(XCN-LOP) ❑ FOOD FACILITY � 54[ID WASTE VC-4-iIG11~ <br /> UN0r-tGR0UHD TANK(MONITOR[NGIREMOVAU ❑ DOG KE=NWEL ❑ DAJRY <br /> HAZAR00US WASTE GENERATOR Q CHICKEN RANCH ❑'0 KG TREATMENT PANT <br /> i7 FACILITY In Ma-rE3d1i01'EL Q PeIMPER TRUCKlYAADICHEM TOILEI•S <br /> 0 YATTTtr=mP�R1w11TTE C7 LAND USE APPLICATIC14 SITU <br /> C:1 A i` <br /> ❑� Y PEIliC! <br /> NG POU>`JSP , <br /> 7ATTC?OlBCIA <br /> E7 MEDICAL WAk5TE FACILITY o PUHLUC WATER SYSTEIJI 0 OTHER(PLEASE SPECIVY A130VE) <br /> 1. List up to torr addresses in the space above. Select the tylpe( s)elf files from the list above by checking <br /> ttte appropriate box(es). At least one file type MUST be seloctal Fax to (209)464-018 dr mail to the <br /> addr.s'indicate;d above. <br /> 2. IVHD will notify the applicant if any EHD files exist An apfSoiRtrttent for review will be confirmed <br /> approximately five business days but no Tatar than tan(10) dayS;afte:r recce:ipt of application. The files <br /> will be held for a maximum of five business days for revee,nr. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an by EHD staff may riot be immediately available fvr review. A new <br /> application m;ky be submlttO when the file is available. j,i <br /> 4. Any file not returned in the same condidorl as released will be reorganized by EHD staff otthe expense <br /> of the applicant. Future file reviews by the same applicant may r"wire a$78.00 deposit prior to Review. <br /> 5. 'T>±K ATIVt appointment dates must be confirmed with EHD stiff#, <br /> 8. Applications received after 3:04 prn will be processed thela 1`next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS . <br /> !3I F <br /> REVIEWED YES NO REVIEW DATE <br /> E11 60 14 DIMMU <br /> I�r 'k <br /> 'I <br /> 1 <br />