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SAN '1QUIPt COUNTYPUE311C HEAL-M c" 'VIC! <br /> V, L'7 <br /> *.,,-.=NIRRQNMENTAL HEALTH QlVlS1`.� <br /> ( 304 EAST WEBER AVENUE,THIRD FLOOIR- 00/056 <br /> STOCKTON CA 95202 <br /> (209)466-3420 <br /> ?3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT G. lO T c S Vie rz's HUSIAIES$IAGENCY Au- <br /> ADDRESS <br /> ADDRESS C 9'e_ Com' <br /> P90KF 1�� U - � � FACSIMLLE1 <br /> TENTATIVE'APPOINTMENT DATE- I TIME <br /> tPlaasc give 110 to husingss days from dao of appllcazion submittw) <br /> CHECK BOX TO EXPEDrrZ RECIUEST-$7 d FEE-REQUEST IN 3 UUSRNESS DAYS <br /> SIGNATURE OF APPLICANT r DATE <br /> FILE ADDRESS <br /> lips; - <br /> _ <br /> .ofi/s <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANS(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT E3 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 1:3 SOL=WASTE VEKICLE <br /> UNDERGROUND TANK WONITOWNG/REMOVAL) ❑ DOG KENNEL CI DAIRY <br /> I-AZ .RDOUS WASTE GENT-BATOR CI CHICKEN RANCH d PKG TREATMENT PLANT <br /> 0 TIERED PERMfFTED FACILITY Q MOTEUHOTEL 13 AUi4P£R TRUCKlYARDtCHEM TOiLETS <br /> 0 TATTOO/BODY PEIRCING d PQOU-SPA Q LAND USI-APPLICAT)GN SITES <br /> ❑ MIENCAL WASTE FAC5LITY a PUCILIC WATER SYSTEM Q 07-HER(PLEASE SPECIFY AB6VE) <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 t)oX(es). At least One file type MUST be selected. FM to(209)464-0138 or mail 12jihe <br /> addrass indirated abov,s. <br /> 2. EHD wilt notify the appliic�ant if any EHO files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(1(l) days after receipt of application. The files <br /> will be held for a mweimufn of five business bays for review. Appointments should be scheduled <br /> aacprd i ngl y. <br /> 3. A file that is actively teeing 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 Fie not r-otwnetf in the same condition as released will be reerUanized by EHD staff at the expense <br /> of the applicant. Future Tie reviews by the same applicant may require a $78.00 deposit prior to review. <br /> S. "TENTATIVF appointment dates must be confirmed with EHD staff. <br /> Applications recelved after 3.011 pm will be processed the next business day- <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _. PHONE FAX INITIALS <br /> REVIEWED YES _-No No REVIEW DATE <br /> so ao 14 Q1Nfroa <br /> TOTAL P.02 <br />