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o reC_ ,\,:r�`c,�U SAN � XQUIN CG�.li�`t�PU8LiC HEAT LTH `T�HVIGES <br /> l— NVIRONMENTAL HEALTH DIVISi <br /> 3D4 EAST WEBER AVENUE,THIRn FLOOR <br /> STOCKTON CA 95202 - <br /> N� (209) 46$-3420 <br />'. ti FNS VV ,_ PUBLIC .RECORDS RELEASE APPLICATION <br /> 41a�LP ANT BUSINESSlAGENCY a_t_j7[�fi Q u/�P'AE;Q �f , ?k. <br /> t <br /> ADDRESS /1 J Wilson c �} CA; �J�]~ <br /> PHONE O!a _ e04 <br /> FACSIMILE GC /�CF <br /> TENTATIVE'APPOINTMENT DATE y + TIME � <br /> (i°Icase give 7 ih 10 busirtiess days from date of Application submittal) <br /> E i <br /> GI-IECK SOX TO EXPEDITE;REQUEST•M EE--R EST PROCESSED IN 3 BusINESS DAYS <br /> SIGNATURE OF APPLICANT _.- __- Q� Q,P.r DATE ��20�ID©,_- <br /> ;j <br /> FILE ADDRESS �{ <br /> g �3_ a c� <br /> 3 s-z-7 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING A13A7£MF-NT In $OUD WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-1-OP) O FOOD FACILITY M SdLlf]WASTE VEHICLE <br /> 13 UNDERGROUND TANK(MIONITOKINGIRi;MOVAL) ❑ DOG KENNEL 0 DAIRY <br /> O HAZARDOUS WAS-M GENERATOR 0 CHICKEN RANCH I? M PKG TEtEAfIJIEN7 PLANT <br /> 13 TIERED PERMITTED FACILITY 0 m01TvLJHQT L 0 PUmPFR7RUCKfYARD1CFtEN3TOiLETS <br /> E] TATT00180DY PEIRCING C7 POQLISPA i'I 0 LAND USE APPLICATION SITES <br /> d MEDICAL WAST_FACILITY 11 PUBLIC WATER SYSTEM {' 13 OTHER{PLEASE SPECIFY ABOVE) <br /> I 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 type MUST be selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHO will notify the applicant if any EHD files exist. An appal toren far 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 an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the rite is available. <br /> 4. Any file not returned in the some condition as released-will E c reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.04 deposit prior to review. <br /> 5. "'TE=NTATIVE appointment dates most be confirmed with EHb staff! <br /> 6. Applications received after 3:D4 pm will be processed the next business day. <br /> ,J <br /> CONFIRMED APPOINTMENT DATE TIME <br /> [SATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> kH 00 U 0110500 <br />