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SA <br /> N �G)UtN GOUNTYPU6LIC HEALTH �VICI <br /> NVIRONMENTAL HEALTH 01VISI <br /> 304 FAST WEBER AVENUE,THIRD FLOOR 00/056 <br /> G E STOCKTON CA 95202 <br /> / (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT G lO T CIS V,Q rps BUSINESSIAGENCY NU- <br /> ADDRESS <br /> `ADDRESST,/- ,[,,,_,.� cn- <br /> PHONE SIS -SO— 9TLJ0� FACSIIMMV F SCO) <br /> TENTATIVE'APPOINTMENT DATE_�I t a I0-o TIME jr>-OD • 1 <br /> (Please give 110 to hLialnSss days from oat*of appllcarim autlmrtWl) <br /> CHECK BOX TO EXPEDITE REQUEST•S7 a FEE—REQUEST PROC[Ssza IN 3 BUSINESS PAYS ..77 <br /> SIGNATURE OF APPLICANT DATE LSI <br /> FILE ADDRESS <br /> ,. - <br /> I aSc> Asgiaup- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOUP WASTE FACILITY <br /> OTNFR CLEANUP$1'TE(NONIOP) ❑ FOOD FACILITY O SOLA?WASTE VEHICLE <br /> UNDERGROl1ND TANK peONROfUNClHEMOVAL) d DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PuW$ER tRUCK1YARDK:HEM TOILETS <br /> M TATTOO/BODY PEIRCING ❑ POOUSPA a LAND USE APPLICATIOH S"FS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUULIC WATER SYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> List up to ten addresses in the space above. select the type(s)of files tram the list above try checking <br /> the appropriate box(CS). At IeaSt one file type MUST be selected. FKx to(209)464-0138 or Mail to the <br /> address indicated Above. <br /> 2. EHD will notify the applicant if any FRO files exist. An appointment for review will he 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 maudmum of five business days for review. Appointments should be scheduled <br /> acaordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for reviow. A new <br /> application may he 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 Tile reviews by the same applicant may require a$78.00 deposit prior to review. <br /> S. •TENTATIVZ 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 DATETIME <br /> DATE CONFIRMED _. PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ril a u Qlffl a V <br /> TOTAL P.02 <br />