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g-2vYne 09.13G1M FROG", Cit<,5 <br /> tutN SAN. �•.r� CDLNTYPUBLIC H{nALTN <br /> `lX <br /> HNVIRONMENTAL HEALTH D{VISfON <br /> 304 E&6T WE9fCR AVENUE,1'HIF2D FLOOR I <br /> STOCKTON CA 95202 <br /> 001 (209)46&3420 <br /> SE APPLICATION <br /> ;LALI H PUBLIC RF-CORDS RELEASE soc . <br /> lausiNESVAGENCY <br /> aqF rAPPI-tCAN <br /> ADDRESS \�`3 , FACSIfrIILE <br /> m i <br /> PHONE ��21 -OY TIME i <br /> s tram Lata of appfla8an 5ti<timttwl i <br /> TENTATIVE'APPOIN(TPww ggive?toinbWM�g `- <br /> SOX TO E7(pEprtE REQVEST•ST6.00 PEE-REQ sypRpOESSED IN3ausINESs DAYS <br /> CHEC DATE <br /> k <br /> SIGNAT RE OFAPPLIGANT <br /> Tµ15 SIDE END STAFP USE ONLY I <br /> F1LE AppRES6 PROGRAM ELEMENTS SEARcH <br /> 3�as �y c Usk hYK <br /> - �' 3s• <br /> Ar - <br /> 1 20 a9�o #A, <br /> � vJirS•r ria� � �. <br /> ENVIRONMENTAL HEALTH DMSION FILES <br /> M HOUSING ABATEMENT co -500 ASTE FACILITY <br /> C3 $01.1 WASTE VeHICLP <br /> ;tI UNDE ROUNOTANK(UST)CLEANUP SIT6.(LOF) p FOOD FACIL[rY Cl DAIRY <br /> �.(OTHE CLEANUP SITE(NONd.OP) o DOo KBdNEL ❑ pKG'ITtEATMENT PLANT <br /> IdUNDE (3ROUNDTANK(MONrrOR1NGRSMOVAL) O cKIcj<MNRAHCH p PUMPER TRUCKIYARD[uHEMTOIIErS <br /> HAZAF OUS WASTE G6Nh>ZATOR ❑ MOTEUNOTg LAND USF gppLICJ�710N SITES <br /> [j TIERED PERMITTED FACILU ❑ POOLISPA O OTHER(PLEAGE SPECIFY ABOYE) <br /> ❑ TATTQ BODY PEIRCING Ck PUI3LICWATER$yMM <br /> ❑ MEDIC WASTEFACarrY <br /> s of files from the i list above by Checking <br /> List up to ton addresses in the space above. Select the type{ ) 013f;or ma1UQAle <br /> ti At least ons fife type MUST be selected. <br /> the appropriate boxes}. <br /> address in Fate ' ove• Intment for review will be confirmed <br /> 2• EHO will notify the applicant if Any EHD files exist An appo s After receipt of application, The tiles <br /> approximately five business days but no later than ten{10)days <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 immediately available for review. new <br /> application may be submitted when the file is available. staff at the <br /> noifflon as 4 of y the not rea tur'Future hfilesame c a by the satnet app aril may requ�e a$7eased will be rewganized 8 0 de po)t prior to evfew. <br /> 51 'TENTATIVE appointment dates must be confirmed with EHD staff- <br /> g- Applications received after 3.00 pm will he processed the next business day. <br /> CONN RRMED MED APPOINTMENT DATE TIME <br /> DATE GpNFI <br /> PHONE FAX INITIALS <br /> _ <br /> REVIE; ED YESr NO REVIEW DATE <br /> M14 TOTPL P-02 <br /> 7 <br /> I <br />