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/ - 2 u I <br /> s /J <br /> ,� AS «("CCS.///..///))) J � <br /> .... .i �' <br /> 1�/{• SAI J6AQ111N COUNTYPUB �J IH�JPI WIJIi L' 1:i,1C HEALTH SERVICES 3 �• <br /> :ENVIRONMEN.TAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ` STOCKTON CA 95202 <br /> (2,09)4683420 <br /> PUJ3.LJC RECORDS RELEASE APPLICATION <br /> APPLI A?•JT z] T)C 011 "(ems\I-r' $USINNt l <br /> ESMAGENCY e-X Y"`C,-r• <br /> A�DDRC S& O l (a,u.8-fc � � ...�r1� Au +Pt--� �_Oo✓�k� 1 �� �� c� � <br /> PHON �')S1 of 400 { FAGSIMIL3? <br /> +� <br /> _ ( 1 S` 35 <br /> TENTATIVE'APPQIN(Ml N,"7 D�ATL'�Y PP TIME <br /> PICC: 7 to•10 iln4*da s from Calc of a licallcn submittal] <br /> WChF_CK 130' X TO EXPEprfE REQUEST-SST.40 FSE-RL`QUUT PROCESSED IN 3 BUSINESS DAYS <br /> SIGN�TURE OF APPLICANT �� _ �,�.:.1� �_ DATE <br /> Fll.t"ADOFE£S$ THIS SIDE t AP VAFF-USE OKUY <br /> j PRQGRAM ELEMENTS SEARCH <br /> (a V L aZ Sa <br /> ` } <br /> YN <br /> 1) '�JCIA31f Dc*, �Zy_ _ —a.. 3 s <br /> 0. ri a�. /1tii <br /> t r .a <br /> r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ,OUN E(GROUNQ TANK(UST)CLRArWIP SITE(LOY) 0 HOU31NG ABATEMENT Q SOLID WASTE FACILITY <br /> E CLEANUP SITE(NOH-LOP] 17 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UN <br /> : , E�GROUND TAttK(MOMTORtNG1itL7ADVAS,) 0 DOG KENNEL 0 DAIRY <br /> T/N DQU5WASTE 13ENEFZATOA 0 CHIcKzN RANCH 0 PXG TREAIMENT PLANT <br /> WTI EPERr>MEO FACILITY O MOTEUH07EL 0 PUMPER TRUCHIYARDICH9MTOILETS <br /> (3 TA =00Y PEIRCING 0 P6OUSPA 0 LANG USEAPPLICAYION SITES <br /> a INS IC ALWASTE�4ACILITY ` O PU$L,ICWATER SYSTEM 0 OTAER(PL9A5E4PECIFYAB0Y£) <br /> •t. � List U to can addrasses'in the space above. Select the type(s)of files from the tilt above by checking <br /> the appropriate box(es). At least ori%filo type MUST be selected. Fax to(21391454-t31'3o or rnaif to thy <br /> address indicated abovd. <br /> 2. ! EHD will notify the ajpplibant if any ZKO files exist. An appointment for review wiii be confirmed <br /> approximately five business days but no later than ten(10) days after recoipt of application,-The#ices <br /> will be hold for a maximum of five business days for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A filo that Is actively beim$Workoci an by EHD staff inay not be immediately available Cot review. A new <br /> application may bo subrbittod wthan the file is available. <br /> Ji. Any filo not returned in the same Condition as released will be reorganized by EHD Staff at the expense <br /> of the applicant. Future dile reviews by the same applicant alar require a 307.04 deposit prior to review. <br /> f3. 'TENTA' IVE appointrnet>t dates must be confirmed with EH13 staff <br /> G. Applications received after 3;4p pm will be processed the next business day. <br /> CON�IkMEO APPOINTMENT DATE TIME <br /> DAT ICF PIFIRNIED PHONE kX- INITIALS <br /> REVigWizo YES no REVIEW DATE r <br /> N iC SA ,D 7JD2 TrrrOt O QS <br /> 71')'_I bn-J T TnnT c iai Nff�l <br />