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b'r-1'7-ridlti 4� 11F M �Iui <br />SAN J'p ' 1[JI t CCUN•TYPUSLIC HEALTH SL..yICF;;S ��,���•ti�. <br />EN1r'fRONMENTAL HEALTH DIVISION <br />`104 CAST VVESER AVF-KUE,Tlj1RD FLOOR U <br />STOCKToN CA 85202 <br />(209) 468,3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />_APPLEC�jf(T ,,.��111 BUSINtSSJAGENCY <br />:AaRR6SS (D l <br />rAC91AilLL' ,�- S " _L <br />i <br />TENTH -FI E-App0IN7MF--4T'DATF-_ `l�t Tlly�� 0J) , i Yl -e__ <br />{plea -4a OwL o btuincss days from date or application I "13 Mal) <br />CHECK BOXTD EXPEDITE R MES OO FEF- _ I'EQ 57 PROCESSED IN 3I3U51NE5S DAYS <br />,SIGNATURE OF APPLICANT <br />DATE <br />• '� Mull,II��IW1lI[�iTrrfai:�i� <br />ENVIRONMENTAL HEALTH DIVISION FiL.F.S <br />VNPERGROUNL) TANK (UST) CLEANUP SFTZL (LOP) <br />OTi- ER CLEANUP SIT4 94OK-LOP) <br />UNDEf;GROUND TANK (44QNgQRIt•iG1ki:rAuvALj <br />�RDOU5 WASTE GEN.R.ATOR <br />TIERED PERM=F-O FACILITY <br />O. TA.iT0018ODY PE(RC[NG <br />Q MEDICALLr'A25TEFACILI7Y <br />❑ HOUSING APATEMENT <br />SOUL) WASTE FACILITY <br />0 FOOD FACILITY <br />SOLID WASTE VEK C L.E <br />M QQG KENNEL <br />❑ DAMY <br />❑ CHICKEN RANCH <br />d PKG TREA71ENTPLANT <br />MQ T EUHQTEL <br />17" PUMPER TRtlCK/YAFZWC1JEA;70ILET9 <br />fl roojBPA "- <br />❑ LAND V5ERPVLICATi0X SITES <br />1� PUBLIC WATER SYSTam <br />❑ 0T74UR {PLEASE SPECIFYAa0VEj <br />'I List up to ten aactresses in the spac0 abevo. Select the type(s) of files from the list abave 4y checking <br />the appropriate box(esj_' At [east Ole fife type MUST ba selected. Fax to (20g)d64.01" ar mai(to [ho <br />dress indicated ab ve: <br />L EHD will notify the applicant If any EED files exist. An appointment for review wilt be canf;irrmed <br />approximately frve busiT ess clays bu,, no later than ten flo) stays drier reciiipt of application,,T" flies <br />will bE held for a maximum of five business clays for review. Appointments should 4e sedulacl <br />accordingly. <br />3. <br />A !7410 that iz RQNYoly being WDrkcc on by Erle staff may not by irnmedlately available far review, A new <br />application may be subrriittcd when the file is available, <br />any ilJc :lot rcturned In t�a same condWan as relaased will be reorganiaod by EXt) staff at the expense <br />Of the applicant Future file reviews by the same applicant may requifo a $87.00 dCposit prior to review. <br />• 'TENTATIVE appointment dates must be confirmed with END statf. <br />6. ApFllca3ons received aiier 3:00 pm will be processed the next business day. <br />QONFIRMED APPOINTMENT DATE TIME <br />I � <br />ATE CQf1FlRMEQ PHONE FAX INITIALS <br />IREYIEVYED YES NCS <br />FiEVi>=111f DAVE <br />TOTPL P.01 <br />