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SAN Jt :UlN CJUNTYPUI3UG HEALTH : VICES ���/� <br /> \\ 1=14VIRONMENTAL HEALTH DIVISION YD <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ++ w <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION n / <br /> �APPIJ N BUSIINESSfAGENCY LW C <br /> A RESS94??J7 ,q, 6k/a/L' 1 69 5S <br /> HONE <br /> FACSIMILE ��9 l�1 i0-/ �l,�Q �q.r� MAY 1 <br /> TENTATIVE*APPOINTMENT DATE ,` s U <br /> TIME IIr•3O RIF ,illi.l' i',, t:I ,-ALIH <br /> (Please give 7 to 1 business days from date of application Submittal) F"rl 1 I I� S <br /> �lv/Ts 3,. x� `rh�S �� par//d)cw- <br /> *CHECK BOX TO EXPEDITE REOU �57a_OD FEE—REO STP OCE SEP IN 3 BUSINESS DAYS 6 l mj y,-'. `7 as I7 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> - <br /> N r }U Cf`d ♦1 tl <br /> 1 y7'adp /(0 236/, �gS a35�J a13o/ ?389 a36 X 360 , 03 a3 239 2-3a O <br /> -23oxIut 25 8o .2 a <br /> Ver Nip tr Ir I� <br /> �Fr N ,t It N <br /> It it it I n <br /> / 1rb //vOyt It?3yo,3+3G2 X360, 2=;t_ 2_39 -23 (�/6(0�0�n �L v1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES CO(,Y,IirMM% <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT ❑ SOLID WASTE FACILITY COMM% <br /> ___ <br /> OTHER CLEANUP SO'I=(NON-LOP) E3 FOOD FACILITY M SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGtREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13PKG TREATMENT PLANT I,,I����// Z 5 ZOOIt <br /> ❑ TIERED PEIWnTED FACILITY d MOTELIHOTEL P PUMPER TRUCKIYARIUCHEM 7(%IC1iTS <br /> Ci TATTOOIBODY PEIRCING ❑ POOUSPA O LAND USE APPLICATION SrrES <br /> p MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ 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 selected. Fax to (2(9)464-0138 or mall to the <br /> address 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 recelpt of application. The files <br /> will be held for a maximum of five busyness days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile that is actively being worked on by EHD staff may not be Immediately 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 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 0a li a1roSVo <br />