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SANQUIN COUNTYPUBLIC HEALTH *ICES <br /> i� ENVIRONMENTAL HEALTH DIVISION <br /> pa 304 EAST WESER AVENUE,THIRD FLOOR _ _74 STOCKTON CA 95202 <br /> (209)468-3420 <br /> )A` / PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 13LISRIE551AGENCY ddVailICe� <br /> ADDRESS p3JSAY) ad, <br /> (y i7(.K.C.a/t+ F _q �ry✓ Ills PHONE �U7 (�(� / FACSIMILE �z/j�' � ! - Ill <br /> TENTATIVE*APPOINTMENT DATE TIME � � 2001 <br /> �J�' (Plea+e gfvo 7 to to business nays frvm dale of application su6mktai) Iii U <br /> 4q� CNECK BOX TO EXPCDI­TF�REQUEST- 7 , o E— QUEST PROCESSED IN 3 BUSINESS DAYS i. i, i t 1L H <br /> SIGNATURE OF APPLICANT �1� DATE 2� Z(�D <br /> . FI ADD S_L <br /> IqYIP E4 <br /> l I 1 <br /> Y tZSlies 1e1r a29S/ <br /> je -- <br /> �& — <br /> 2y,S /1')L <br /> S Ulf Y t 3F2 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ KOOD FACILITY ❑ SOLID WASTE VEJTICLE <br /> UNDERGROUND TANK(MONVORINGIREMOVAL) ❑ DOG KENNEL o DAIRY <br /> 14A7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOUBODY PEiRCING M POOLISPA Q LAND USE APPLICATION SITES <br /> G MEDICAL WASTE FACILITY ❑ PUBUC WATER SYSTEM 4 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At least One file type MUST be selectod. Fax to (2991464-0139 or mall to She <br /> dress indicated above <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 after 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 an by EHD staff may not be immediately available for review. A new <br /> application may be submittod when the file is available. <br /> 4. Any file not returned in the same condition ae 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 EHD staff. <br /> 6. Applications received after 3.00 pm will be processed the next business day_ <br /> CONMMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Bi M 14 01N1pa M <br />