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UATERECEWED <br /> SAJt1,..�UIN COUNTYPUBLIC HEALTH SE CES <br /> (,,5 <br /> ENVIIRONNIENTAL HEALTH DIVISION 7 304 EAST WESER AVENUE,THIRD FLOOR STOCKTON CA 95202 <br /> (209)488.3420 <br /> _P,4PLIC RECORDS RELEASE APPLICATION <br /> d 6�vav �� <br /> APPLICANT SUSINESSIAGENCYAnv + <br /> P't <br /> ADCIMSS <br /> _ <br /> FACSIMILE 10 9 <br /> TEiVTAT1VE'AP1'otfrrMErt71aATE �?t iG , rIME law o <br /> (Plewsn siva 7 lu 90 businass&ys"m data of application submittal) <br /> C>jECK BOX TO EXPEUItE REG UE 74.OA FEE-REOuE^T ROCESSED IN 3 OUSINESS DAYS <br /> iGNATURE OF APPLICANT DATE Ze&/,I/ <br /> FILE ADDRESS <br /> r E <br /> {t 4 <br /> i <br /> t' �f 3 •X% Imo- 25• ��-c. <br /> 1 <br /> D r .� <br /> 05- It 35.x+ Gp <br /> in <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> tIN13ERGROUNI)TANK JUST)CLEANUP SlfL(LOP) 0HOMING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SrM(NON-LOP) 0 '000 FACILITY 0 501.10 WASTE VEHICLE <br /> UNDERGROUND TANK(MONITURINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN"NCH © PKG TRF-ATNTNT PLANT <br /> TIERED PERMITTED FACIUTY Ci moTrtfLiHoTEL ❑ PUMPER TRUCKryAR=jjFM-TOILETS <br /> TATTOomaLry PEIRCING Cl POOUSPA 0 LAND USE APPUCATION SITE$ <br /> 13 MEDICAL WASTE FACILITY d PtI811_IC WATER SYSTEM 0 OTHER(PLEA-SE SPECIFY ABOVE) <br /> '1_ List up to ten addresses in the spat©above, Select the type(s) of files from the list grove by checking <br /> the appropriate boxes). At least one file type MUST be selected. Fa to 209 464-01o it o tis <br /> address indicated Q ove. <br /> 2. EEO 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. Appoinimentsc should be scheduled , <br /> accordingly. <br /> 3. A fila that is actively being-worked on by EHD stafF may not lee Imrnediately avallable-for review. A new <br /> application may be submitted when the file is available, q <br /> 4• Any file not returned in the some condition as toL!14ased will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the Sam"a applicant may require a$78.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must he confirmed with EHD staff. <br /> 6- Applications received after 3:00 pm will be procassed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _. PRONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE _ <br /> �K oU i4 0110910 <br />