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SAN J*WWWN COUNTYPUBL.IC HEALTH S�/10ES <br /> i ENVIRONMENTAL. HEALTH DIVISION � _ 1 <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> / PUBLIC RECORDS RELEASE APPLICATION <br /> AYPLiCANT ✓/N^�jG� HUSANESSIAGENCY �{(�ffd, � Ii l�i��J d1 <br /> ADDRESS O .J _ *L <br /> j� / 1 <br /> PHONE U r FACSIMILE (L� �f� ! /�� _ `'i- r <br /> TENTATIVE`APpOlWrMENT DATE TIME <br /> (Please give 7 to 10 business clays from date of applicationit <br /> submtal) rM2 5 2001 <br /> 5T CHECK BOX TO Expejirn2 REQUEST- E— C;' '!i =1 J i f "�\L H <br /> GiUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTN C3AT1; <br /> �I ADD VgS� <br /> _ aFsi - <br /> 3szg 1 <br /> c 4 <br /> Aa 10'k <br /> L 3 5 ;X$ rK, <br /> 25.5 Mc <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGRaUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT b SOLID WASTE FACILrrY <br /> QTHER CLEANUP SITE(NON-LOO) E7 !40p FACILITY 4 SOLID WASTE V1=li[CL E <br /> UNDERGROUND TANS(moNITORING/REbmOVAL) ❑ DDG KENNEL 0 DAIRY <br /> HAZAR00US WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br /> ❑ TIE-RED PFRMRTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARDICHEM TOILE-M <br /> ❑ 7ATtWBODY PEIRCING M POOL SPA Q LAND USE APPLICATION SITES <br /> d MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM 4 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses in the space above. Select the type(s)of files from the list above by checking <br /> the approprlaW box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to thEE <br /> address indicated abpv[s. <br /> 2_ EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days aftOr receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by EHD staff may not be lrnmediately 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 reorganizer(by EHD staff at the exp*nSo <br /> Of the applicant F tUture'fiie reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processod the next business day. <br /> CONrIRMED APPOINTMENT DATE -nME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWE=D YES NO REVIEW DATE <br /> area 14 01l05A06 <br />