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2@94671' AGE STCCKTON PAGE 02 <br /> � U�� SAN J(%,4UIN COUNTYPUBLIC HEALTH S VICES <br /> ENVIRONMENTAL HEALTH DIVISI6e <br /> OC 8 �0�0 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> AVIRONMENT HEALTH (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT.-"j DUSINESSIAGENCY Ut UC1JILP �13Uf�^D / � .[l Z Ztx. <br /> AlD>zEss �11d S! /� �D41 <br /> PHONE U FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE <br /> (Please give 7 to 1 a business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$78.0 EE--RE FST PROCESSED IN 3 EILISINESS DAYS <br /> SIGNATURE OF APPLICANT _ ._� 1�� DATE <br /> FILE ADDRESS <br /> s - <br /> I , <br /> ENVIRONMF-NTAI- HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> �( OTHER CLEANUP SITE(NON-LOP) la FOOD FACILITY i7 sOLID WASTE VEHICLE <br /> iZ UNDERGROUND TANK(MONITORWGIREMOVAL) 0 DOG,KENNEL 0 DAIRY <br /> 1.X 14AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> C7 TIERED PERIiITf'ED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKIYARD)CHFU TOILET'S <br /> 0 TATTOO1500Y PEIRCINGQOIISPA <br /> ClCl0 LAND V.5EAPPLICA7lON SITES <br /> 0 MEDICAL WASTE FACILJTY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(5) of files from the U.St.above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 20 464--0138 or rn it to the <br /> address indicated abeve. <br /> 2- EHD will notify the applicant if any F-117 files exist. An appointment for review will be confirmed <br /> apgraximately 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 schaduled <br /> accord irsgly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for roview. An W <br /> application may be submitted whack 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 $78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 8,. Applications received after 3:00 pm wilt be processed the next business day. <br /> CONFIRMED APpO1NTMENT DAT>; TIME <br /> DATE CONFIRMED PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> en oo- s• mrovoa <br />