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Klw LDC.FR Bf A <br /> SAN JG-4UIN COUNTYPUBLIC HEALTH 5...,.-,VICESENVIRO <br /> Y' ISION <br /> 304 EAST IVY WEBER AVENUE,THIRHtALTH D FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> �PUBLIG RECORDS RELEASE APPLICATION <br /> APPLICANT l+�lseri�[ �Lvr t1(� � B11SlNf=5S1AGElyCY COtrtia{pyc.r'} rti �,r� C�tr�ti �vu�eC TKA, <br /> A00RESS is �ror1Lc 1/�I�� E' Cti✓`���z� '�.'A � - —I-or�, C clS�c] �v <br /> PHONE ZO`l - ;2- - C $t VACSLMILE <br /> TENTATIVE*APP'Olt"MENr DATE 1� /14> LZO01 'nmE <br /> (Plans&0wo 7 to 111 b in G"days from date of application sub"Hal) <br /> TS 1, <br /> CHECK e0X TO EXPEIXTE REQUEST =$7.00 FLEE-REQUES64 SSED I 3 BUSINESS PAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIVE EHL)STAFF USE ONLY <br /> PROGRAM ELEWAITS SEARCH <br /> -q 2.O "S. <br /> 2 S. Ga.Ei-�ertni�4 <br /> ly <br /> Sao S_ Ca.1� rH ;A. 3 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> NnMGROUND TANK(UST)GLE.ANt1P$rid(LOP) L7 -()LISiNG ASATEAWNT C1 SOLJD WASTE FACILI TY <br /> Q�� ER CZE UP SM(NON4,011) MIFOOD FACIL" Q SOLID WASTE VE II= <br /> NDERQROUND TANK(MONITORINGiREMOVAL) _ Q DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENF-BATOR © CH;CKEN RANCH C) PKG TRF�ITMNT PLANT <br /> 0 TIEt1t0PERNrrTE-Q FACiLPiY 0 MOTELIHOTFI. b PUMPER TRUCKlYARIWCHEM TOILETS <br /> CI TTOO1B0UY PEIRCING 0 POOL f8AA la LAND USE AAPL ICA-1710N SITE'S <br /> bir MEDICAL WASTE FAC1LnY Cl PUBLIC WATER SYSTECI Cl OTHER(PLEASE SPECLFY AJROVE) <br /> 1. List up to ten addresses in the space above. Select the type(S) of files frorn the list above by checking <br /> the appropriate box(es). At least one File type MUST be Selected. Fax to (299)464.0138 or,mail t4 tP <br /> addrgss indicated apgYe. — <br /> 2. EHD will notify the applicant if any EHO files exist. An appointment for review'will be co>tfirmad <br /> approximately five business days but no later than ten (10) days after receipt of application. The flies <br /> will be held for a maximum of five business days for review_ Appointments should be scheduled <br /> accordingly. <br /> 3. A fife that Is actively being worked on by EHA staff may not be lmmediateiy 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 reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 4aposit prior to review. <br /> 5. 'MUTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> 4ONFIRMED APPOINTMENT DATE _ _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />