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_� SAN .' %QUIN COUNTYPUBLIC HEALTH 'ZVICES <br /> 'LNVIRONMENTAL HEALTH DIVISIM— <br /> MAY z 20�� 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468420 <br /> LiII PUBLIC RECORDS RELEASE APPLICATION <br /> / <br /> APPLICANT ^ 4 F ! J�`f SU51NE/SSIAGENCY CC�;+Y/d o v L'<Lr 1�L) fC�yc�Hr�a ba7 r tel,�+9C. <br /> ADDRESS <br /> PHONE_CO( L7—c; 3Q, L7.I�IS FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE '-/�Jf0 I T7NIE <br /> (Please give 7 to 10 business days from data ofappli"hun submittal) 0 D <br /> C <br /> 17 CHECK BOX TO EXPEDITE REQUEST <br /> -$ 7.00 FEE—REQUEST PROCESSED INS BUSINESS DAYS J <br /> SIGNATURE OF APPLICANT _ o ze ` � DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 9v <br /> 0 1 c I.tr rkeatz NIL <br /> S9Lo �3 <br /> Soa 1C� . -210,,Z233 Jt q,23 0 2 $o, o <br /> ro 2227 <br /> 7 t )-,^ N �si� <br /> 5C1 I 14Ve t ro ,922C.,-739 <br /> i <br /> �.,/ ENVIRONMENTAL HEALTH DIVISION FILES <br /> W�.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT K SOLID WASTE FACILnV <br /> ,tA OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY p SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNET. ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEAJHOTEL ❑ PUMPER TRUCKIYARWCHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCIt1G ID POOLMPA ' - Fr LAND USE APPLICATION SrrES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 (209) 464-0138 or ma I tp 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 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 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$87.00 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 /> f <br /> \ CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFI ED PHONE FAX INITIALS <br /> REVIEWED E NO REVIEW DATE <br />