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_IJYt t. ..�i _ �� �� �_� <br /> '+a{Ui►'a.1,iJLF(ti i 1 S"UiiLta.� tlL::.A15L.1 i':l a v—.+ <br /> ENVIRONMENTAL HEALTH Dli/i; � <br /> 304 i-1ST WEBER AVENUE,THIRD FL <br /> STOCKTON CA 95202 <br /> (209)488-3420 <br /> I <br /> PECK RECORDS RELEASE APPLICATION <br /> l ` �'` nusinEssrAG�ricir Q�UdYtC�� ,_�-�1�1/r`�lf�'1�OI��/�if� <br /> APPQCANT <br /> ADDRESS W <br /> PHONE FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE ^� 42. ! tf�d.v� <br /> (PleasegiveTto'16 b arn dateof appllritlon submittal) <br /> <11 <br /> CHECK BOX TO EXPEDITE RF0UF_5T- 00 FEE QUEST pRCCSSSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLDATEICANT • <br /> FILE A"Uttr_SS <br /> 3s.ac, <br /> VA <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE- (LOP) 0 HOUSING ABATEIMII NT '❑ SOUD WA3TE FACILITY <br /> aTHER CLEANUP SOLE:(N O LOi') Cl F-000 FACILITY 0 SCUD WASTF-vE--LIICL E: <br /> UN0FRGR0tjND TANK(MONIT'ORINGWLEWVAL) ❑ DOG KEN NEL ❑ DAIRY <br /> HATAI2!)QUS WASTE GEhIEfZp,Tt7R CI CHICHEN RANCH ❑'PKGi TfiFATMENT FLAW <br /> ❑ TIEREApERMIITEDFACILITY d MOT-UHOTEL. C] PlI6Nl�t~l2"rRUCKlYAFZAICNEIY!TQis_I=iS <br /> ❑•-rA"r`}=J3,oVy PEIRCING C3 FOO�J*PA C7 LAND USE APPLiCA-110K SITES <br /> ❑ rAF-DfCAL.VWA517E FACILITY 0 PUSUC WATER SYSTEM ❑ OTHER(PLEASE SPIECI>r.Y ABOVE) <br /> t. List up to ten addresses in the space abava. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least ane file type MUST be seloctdd. Fax to 209 464-013 nnr mail to the <br /> 00 lss indicated above. <br /> 2. CHD will notify the applicant if any EHi3 files axisL An appolntMent for revieW will be confirmed <br /> approXiMately five bU51t1eSS days but no later than ten(10) days after receipt of application. Tree files <br /> will be helot for a MaXirrlUM of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is activeiy being worked an by EHD staff may not be immediateiy 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 lye reorganized by F-HD staff at the expense <br /> or the applicant. Future'file reviews by the same applicant may r"vire a$78.00 deposit prior to mviaW. <br /> 5. 'TENTATIVE appointMen#dates must be conramed with EHD staff. <br /> 6. Applications rfaceEived after 3:00 pro will be processed the next bUSiness day. <br /> CONFIRMED APPOINTMENT f)AT>; TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RMEWED YES NO REVIEW DATE <br /> Elf 0414 M10503 <br />