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y��fE i{�GEIYEO Q11%LOG xvWVA <br /> J4 U <br /> p AN IN COUNTYPUBLIC HEALTH SWICES <br /> [RECO V E0 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD <br /> FLOOR <br /> A U G4 0 STOCKTON CA 95202 <br /> .Wg)468-3420 <br /> Ul LTH PUBLIC RECORDS RELEASE APPLICATI-ON <br /> �+ - mslNESWAOENCY <br /> PNGtuz "• t FACSIMILE <br /> TENTATtVE"Ap oINrM1=Nr OAT- n Twr= <br /> dace pt ap�iiCd <br /> (Please give 7 to tD b%minoss tram tlen BtiAmitl�d) <br /> 0311-CRECK BCUG TO EXPECrrE REC3UW_ -b .Ob FEE--REQUEST PROCESSED IN 3 BUSINESS PAYS ' <br /> ja22!0 <br /> SIGNATURE OF APPLICANT BATE <br /> FILE ADDRESS <br /> e 0 r • <br /> I goo . <br /> 1NOI <br /> ENVIRONMENTAL HEALTH V VISION FILES <br /> W tDERGROUND TANK(LIST)CLEANUP SITE(LOP] O7' HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(MON-LOP) 0 F<KM FAC1611TY ❑ SOLID WASTE u[lilCLt; <br /> UNDERGRODUO TANS(MO NITORINGMEMIDVAL) D DOG KENNEL LA DAlkV <br /> d HAZARDOUS WASTE GENERATOR ❑ cNICiiEN RANCH 0 PICC TREATMENT PLANT <br /> Q TIERED PF9MnTEDFA.CILITY CI #AajELJN0T9L 0 PI)FAPER TRUCKJYAR=HIM TOIL <br /> 0 -fATCMEODY FIEIRCING d POOLISPA CJ LARD USEAPPLIC PON SITES <br /> 0 mEDICAJL wAsTE FACILITY 0 PUBLIC WATER SYS'lVA ❑ OTHER(PEASE SPECIFY AUOVP <br /> I list up to tell addre***9 in the$Paoe;abOve, Select the type(s) of files from the li_5t above by checking � <br /> tha appropriate box(es)_ At least one'file type MUST be seleCted- Fax to 209 138 or mail to th <br /> addre s intiltated abo s <br /> 2. I_HD 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 on ny EHD staff may nvt be immediately available for review. Anew <br /> application maybe submitted Ywhen the rile is available. <br /> 4. Any file not returned in the same condition as releasid will be reorgan¢ed by EHD Staff at the expense <br /> of the applicant. Future file reviews J�y the same applicant may require a$78,40 deposit prior to review. 1 <br /> S. "TENTATIVE appointment nates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE 'itME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> MvIEVVED YES NO REVIEW DATE <br /> ETI a0 t� Ow4JfOa <br /> TOTAL P.02 <br /> I <br /> I <br /> l <br />