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-- - r•r- r <br />r � r • <br />• <br />�AiN .oUAVUIN UUUI41 YFUULIU tlt:AI_ I H JLRViGES <br />ENVIRONMENTAL HEALTFI 0IV1510N <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />✓ � <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />Fii <br />ifV <br />APPLICANT __, /Ilil w Z41M La t? i ,r BUSINESSIAGEf4CY �7 c �wr�7 r ,� �P�f s,.f <br />�rN f� Z <br />ADDRESS Z t��fyi/I/igrN �1`{ f �/S �C/'rF.�9 li/� FZL <br />S <br />> <br />PHONE - �to y- � ���� XACSLMILE <br />/ <br />TENTATIVE, APPOu�rMENT]DATE 4/2 Pt -1190 TIME 449 <br />FT, y i Z\ <br />-7 <br />d <br />IPfesse ghm 7 to 10 bu5ine days from date of appllcatlon submittal)-) <br />C:D <br />j > <br />CHECK BOX TO EXPIEDITE REQUEST - $73,00 FEE - REQUEST FRUCESSED IN 3 BUSINESS DAYS <br />SIGNATUREpFAPPLfOANT DATE <br />dr <br />-- - r•r- r <br />r � r • <br />• <br />o� <br />av-S <br />�D <br />000 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK US CLEANUP SITE LOP Q MOUSIW ABATEMENT O SPUD WANE FACiu ry � <br />rjTHE.R CLEANUP 511'E {NOK -LOP} 0 FOOD FACILITY ❑ SOLID WASTE 11EtIrGE-5- 3/ <br />Cl UNDERGROUND TANX IPAGNITORINGJRE.MOVAL) CI DOG KENNEL 11 DAJRY <br />a HAZARDOUS WASTE GENERATOR CI CHCIEN RANCH D PKG TREATMENT PLANT <br />Q TIERED PERMrrrED PAGIUTY ❑ MUTELJROTEL a PUMPER TRUCKIYARDICHEMTOILETS <br />❑ TATT001500Y PEIRCIMG ❑ POOU3PA U LANE) USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY D PUSLIC WATER SYSTEM 17 OTHER (PLFA$Ir SPECIFY ABOVE) <br />1. last up to ten addresses in the space above. Select the type(s) of files from the Iist above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to.1209) 464-0138 or mail to the <br />addm- inOicafed abov_e_,_ <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 fi le that is actiV" 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 END Staff at the expense <br />of the applicant_ Future file reviews by the same applicant may require a $78.00 deposit prior to rsview. <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 />CONFIRMED APPOINTMENT DATE TIME <br />I <br />DATE CONFIRMED PHONE FAX INITIALS <br />RFVIMI ED YES NO REVIEW DATE <br />EN N 1A OV24GT0 <br />TnTAI P PrD <br />TOTAL., P. EQ <br />c <br />0 <br />Q <br />