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Imo. .. <br /> _ 4 <br /> 0^1v -KUMLlU)N VUUN I YPUBLIC HEALTH 5ERVIGES Ill 1� ��. l <br /> r1�® ENVIRONMENTAL HEALTH DIVISION 1113 � �,I <br /> _ 304 EAST WEBER AVENUE,THIRD FLOOR 111 I `'r <br /> Lim � '- � STOCKTON CA 05202 <br /> tzas)ass-3420 MAY 0 51000 <br /> PUBLIC RECORDS RELEASE APPLICATION ,, ) - ;:.,I-N1 AL HEALTH <br /> C <br /> -•Occrr'0 APPGr,AwT DUSINESSTAGC ENCY`isPFS.fJ�r <br /> ' nIFP ADDRESS e .r —1? e/S <br /> Sci/4t <br /> � <br /> PHONE FACS 7 <br /> ILE <br /> TENTATIVE'APPOINTMENT DATE Js TKuc /•'PUJY/ <br /> (Please give>tn tOb mess days frdn Pate el aPPlifatlan wbmlelW) f <br /> xCHECK BOX TO EXPEDITE REQUEST- 6.00FEREQ . PR ESSED BUSINESS OATS <br /> N <br /> SIGNATURE OF APPLICAT � w>1 <br /> c` <br /> DATE ✓ <br /> FILE AgDRFsS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELOMEM$SEAACN <br /> O C1 <br /> ' I <br /> 1 ENVIRONMENTAL HEALTH DIVISION FILES <br /> �j97AADOL% <br /> ERGROUND TANK(UST)C4FJANur ame 6O% n l+DUSWG ARATEMEW 0 SOUD WASTE FACILITY <br /> HER CLEANUP SRE(NON.LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> DOG <br /> NNEL <br /> WASTNRATOR WRT_.MOVAL�0 K�DTELnDAIRY WASTE GE RATOA 0 GtICKEMRM+CH ❑_PRG3RSwTaeENY:P.tu17__. - _ _ .._._- <br /> - — _ —�,Q PUOiPER iRUCNYMO'CN9tTO1LEiST.. �— <br /> �in O TAYra L.WASTQDY E <br /> 0 POOV$PA O LAND usEAPPLICAT)ON$lTES <br /> MEDICAL.WASTE FACIUYT O PUBLIC WATER sy=m' 0 OTHER(PLEASE SPECIFY ABOVE) <br /> ' 1. List Up to ten addreoaas in tim space Strove. Select the type($)of files from IDs list above by checking <br /> �. the appropriate box(es), At least one file type MUST be selected. P"to(2091063-0138 or marl to the <br /> 919dratss indicated above <br /> 2. END will notify trig 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 ides <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A f4c treat is actively being worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any rite not returned in the same condition as released will be reorganized by END staff at the expanse <br /> of the applicant. Future file reviews by the same Applicant may require a 578.00 depo4it prior to review. <br /> 5. <br /> 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be pfocaased the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS - <br /> REVIEWED YES NO REVIEW DATE r <br /> A <br />