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0",TE RECEMCD <br /> SANNtirdAQ tRQNMENTA HEALTH DIVISIOoUNTYPUBLIC HEALTH N <br /> EN <br /> • 3D4 EAST WEBER AVENLiE,THIRD FLOOR � <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE^ APPLICATION <br /> APPLICANT N��� --t'(-eZ —BUSINESSIAGENCY <br /> ADDRESS �� 1 <br /> PHONE FAC/SIMILE_ �f <br /> TENTATIVE*APPOINTMENT DATE <br /> / 1//0 / TIME <br /> (Please give 7 to IQ business days from data of appl"ication submlttaE) <br /> EDCHECKBOX To EXPEDITE REQUEST-S87.00 FEE—RE I�PROCESS DIN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> FILE ApDRESS - THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 131 D W rc.r.b f:.,c ?rte Cs4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Q HOUSING ABATEMENT �SOLID WASTE FACILM <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 FOOD FACILITY E] SOLID WASTE VEHICLE <br /> THER CLEANUP SEMS(NON-LOP) ❑ DAIRY <br /> NDERGIROUND TANK(MONITORMWREMOVAL) 13 DOG X17 CH CKEN'RANCH a PKG TREATMENT PLANT <br /> HAZARDOUS WASTE.GENERATOR El M07E�O�L ❑ PUMPER TRUCKlYARINCHEM TOILETS <br /> TIERED PEI�IAITTED FACILITY E3 POOUSPA ' ❑ LAND USE APPLICATION SITFS <br /> ❑ TATTOolgODY PEIRCING ❑ PUBLIC WATER uYSTEAI ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above- S®lect the type(S)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-013$or mai{to the <br /> address indicated AP Y ointment for review will be confirmed <br /> 2. EHD will notify thea licant if an Et-ID files exist to app days after receipt of application. The files <br /> approximately five business days but no tater than ten(�0) ay ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for rew•�ew. nev+ <br /> application may be submitted when the rile is available. staff at expensf <br /> 4• Any file not returned in the <br /> some condition as released ant Mawill be y req uiirre a$87ganized .00 de posit procto eviev <br /> of the applicant. Future file reviews by the sane app Y 4 <br /> 5. a*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 /> CQNFIRAflED APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS 1-- <br /> REVtE'WED YES <br /> NO REVIEW DATE <br /> En vv ++ aeiorroa <br />