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e,aT: nece�va D 1 E. <br /> } <br /> TYPUBLIC HEALTH SEMVIC S a��++u eEa <br /> �0� TAI^ HEALTH DIVISION <br /> c�'� Z. ER AVENUE,THIRD FLao <br /> STOCKTON CA 195202 <br /> l ENS HSP (209)493.3420 <br /> ONM 10ESPUBLIC RECORDS RELEASE APPLICATIO <br /> F'PLICA4r G V CO)P L51NEs5lggEucY �6 <br /> 04. ZS <br /> E PHONE t T' FACSiR91�f 4 -- <br /> TF-NTATFVE"ApPo,NTMFN-r BATE TUNE <br /> iPlease give 7 to l bUsilms3�mys fromdatepf atrpi;catl4R submittal) <br /> �1 <br /> CHECK W)X TO EXPEWrrz REQUEST- 3.00 FEE-tiE4UEST 0CE53E0 IN 3 B1131NESS OAY i <br /> fijiH- <br /> SIGNATURE OF APPLICANT p�TE <br /> i <br /> t; <br /> I"lt.E ADDRESS TNIr6 SID E 'GAFF IISE Mik LY <br /> A 1 ;0% 1 r) PROGRAM 901MEmrs S ARCK <br /> i <br /> L: <br /> Ji <br /> e �7 <br /> 1 til <br /> r <br /> I +, <br /> r <br /> ENVIRONMENTAL HEAL.T3(DIVISION Fll ES <br /> UNDX RGROLIND TANK(UST)CLEANUP SITZ(60F) 0 HOUSING ABATEMENT C) SOLID V&TlE FACILITY <br /> OTHER CLFANUP SITE(NoigN Lop) FOOD FAr-IWTY ❑ SOLID W*STE VEMCLE <br /> UNDERCROVNI)TANK(M ONiTORING/PtEMOVAI_) D 000 KE:PItIFL ❑ DAIRY <br /> HA2ARDc3US WAS7t GFNEIiAYQfj D CHICKEN RANCH d pKG TR TNfEhrf PLAINT <br /> SISRE©AER[�I11'TEA FACII fTY Q rdoTeIJW0TEL O f*A1M?E UCKEYARdlCHEF�tT4(1.M <br /> TATr<)Cl9DDY PE=iNG ❑ PCOLISPA LAND V APPLICATION SrrE$ <br /> PAP-DICAL WASTE FACILITY 14 PUAtAC WATER SYSTEM 0 0'r tER LEAS$&F=FEClt"Y ADO ) <br /> �. Last up to tett addresses in the Space above. Select the � <br /> P type(s)of files fuorn,'.he list alsove by cHeciclrlg 3 <br /> the appropriate box(as). At least an*file type MUST be selected. Fax 12 11-20 464-M38 or mil to tl e <br /> address indigafed above. <br /> EHD wilt notify the applicant if any EHO foes exist. An appointment for MVJCF wlf!be Confirmed. approximately five business days but no later than ten{10}days atter receipt;of application. The fifes <br /> i will be held for a maximum of five buslneas days for review. Appointments Rhould be Scheduled <br /> accordingly, <br /> A Fite that is activisly being worked on by EHD staff may not be Immediately o vailable for review. q new 1 <br /> appliratibn tray be submitted when the file is avai(jjble. f <br /> 4• Any file not returned in the sante condition as released will be rscrrganised li,�EHO staff at the expense <br /> Of the applicant. Futum.. file reviaws by the same applicant may roqufre a Pf:-00 deposit Prior to review. <br /> $. •TENTAti'IVF, appointment dates MLitt be confirmed with EHD staff. <br /> �• Appli"tiOtU received after 3:00 pm will be processed the next business da <br /> ! CONFIRM APPOINTMENT DATE TIME <br /> ` IDATE CON IEZnmEC i <br /> � l P1iOFil� FAX mi IALS <br /> EVIIwW€D YES <br /> as<� <lau <br /> REVIEW naT€ <br /> UNIT <br /> TQTAL P.132 <br /> If " <br /> ILE COPY <br />