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nn SAN JC• -I[l{l�F COUNTYPUBLIC HEALTH SE• _ICES ernLo6�,,,�c Y <br /> �_, r'VIRONMENTAL HEALTH DI SI �'9 -�3,:f Y <br /> 344 EAST WEBER AVENUE,THIRD FLoon <br /> STOCKTON CA 95202 <br /> (MS)4W-.ZA20 I� � <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT VL- [ V. RUSINEWAGE;NCY �11D �► - �WS1,? S ��1C, s <br /> ADDRESS (�i t'=q t_ 11(Lr d ;� <br /> ]]��[. .r S <br /> PHONE �jr;irZll�- � FACSIMILE <br /> TENTA7lV6"APPot1aTmEwm-rE /Z-3o- a/ PrAE 1i ; <br /> (Please Rlve'7 to 10 bgsinms days from data aappCCatian zmd;m" <br /> CHECK BOX TO EXPEDrM REQUEST•$76.00 F REQUEST PROCESSED N 3 BIJSJKMI�DAYS � <br /> [ SIGNATURE OF APPLICANT a DATE _r <br /> if <br /> FILEADDRE S it <br /> a <br /> AZ <br /> C,0 P .t <br /> 13 2-0 <br /> ! l r�/V It <br /> ENVIRONMENTAL HEALTH O SIGN FII_ESp <br /> UNDERGROIJ TAMIL(UST CLEANUP SITE(LOP) O HOUSING ARA7FNENT-, �j ClSOUI)WASTE FACILrrY <br /> 5NDERGROURD <br /> THER CLEANUP SITE(NON4jD fl C) T-000 FAGtLTTY ;j ❑ tOL1D WASTE VEMCLE <br /> TANK(MO"ITORING&EMONAL) O 00G IMMUEL i! ❑ dA1RY <br /> AZARDOUS WASTE GENERATOR 0 CtCUKEN HALM D PKC;TIMATMENTPWWr <br /> I t, TIERED PERMrTTED FACILITY Q MOTELIHOTEL 3 ❑ PUMPER TRUCIVYARDICHEM TOILETS <br /> S 13 TATTOOIBODY PEIRG.W(a C3 POQLMPA ! G LA n USE APPUCATION SITES <br /> E3 MEDICAL WASTE FACILITY ❑ PUt3t_IC WATER MTEM ❑ OTHER(PLE"E.SPECIFY ABUT) <br /> I� <br /> 7, 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("). At least one file type MUST be selected_ Fa7ic to 09_464-0138 erjpgj to the <br /> addfaTs_t iCated above- �} <br /> 2. END 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 /> Witt be held for a maximum offive business clays for revtew. Appoirrfrnents should be scheduled <br /> accordingly. r <br /> 3. A file that is actively being worked on by EHO staff may not bellimmediately available for review. A new <br /> application may be submthted when the file Is available. <br /> 4. Any file not retur»ed in thn same l4,arIditidn as released will be�reorganized by EHD staff at the expense <br /> of the applicant Future file revieWS by the Same appliCanf may requ e a$78.00 depositprior to review. <br /> 6. 'TENTATIVE Appoint mont datoe must tae confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the naxt business day. <br /> 1J I� <br /> 'L iv., •,,•�_ :d .iiN .F0.. � ,} ! '_'Y:�rM•t' , '`4�,*•���-.� <br /> 'RSV ---� r�r',��;, �,�,-. .- ...�'•.:}•::r;-',. ��"`.=_>�.;,�.'x�x�...�'`_� ���!I..._.�.7•�.�'•',�•_;iz�_�'= -`.,F',,.{,} _ _ ..� <br /> WSW <br /> ` TOTRL P.e2 <br /> r <br /> �r <br />