Laserfiche WebLink
W.Ic KL-S.LtrCU <br /> N JC,41N COUNTYPUBLIC HEALTH SE' '1GES i <br /> e- E1�VlRONMENTAL HEALTH DIVISION+— <br /> 304 EAST WFRMAVENUE,TWRD FLOOR <br /> r, STOCKTON CA 95202 <br /> (209)46420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> 1 ri <br /> APPLicatrr__I �m C �} �,.�_BUSINESSIAGENCY 1 <br /> ADORSS,��_� �frTl� ef� . <br /> LL � !� <br /> PITONS�g ` �7� L3't/'"-' FACSIMILE <br /> TEN-CAT)VE{AppoiNTmENTDATE TINE <br /> (PLm*e0ivo?ta10bu5V"9dtkyr,f dada of application submittal) <br /> 9-CHECK BOX TO EXPEDITE REQUEST- 04 FEE—REQUE57 ROCESSED IN S BUSINESS DAYS � • G <br /> SIGNATURE,OF APPLICANT DATE ' <br /> • FILE ADDRESS <br /> J <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> &-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEMEKT W SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITEE(NON-LOP) O FOOO FACILITY = SOLID WASTE VEHICLE <br /> e�FR+3RpUND TANK(IvtQMt7OW NGIRPMOVAL) ❑ DOC+KSNKEL ❑ DAll7Y <br /> R9WAST$GENERATOR n CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> R,$ERIYSf]TED FAC�rrY ❑ NOR�HOTEL El PUMPER TRUCKfYARDIcHENTOILM <br /> ❑ TATTOOISODY PEIRCING 0 FOOLISPA Q L Alin USE APALICATK)N SITES <br /> 0 MEMAL WASTE FAIZXITY 04—PUBLIC WATER SYSTEM ❑ OTHER VLE AP-SPECIFY ABOVE) <br /> List up to teen addresses In the*pace abovB. Select the type(s)of files from the list above by checwng <br /> the appropripte box(es). At least one file type MU!Srr be selected. Fax to 404-0138 or mail to th <br /> address Indleat®d abCVB. <br /> 2. EHD will notify the applicant if any END files exisiL An appoiretrrlerstfior 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 tield for a maximum of five business days for review. Appointments rihould be scheduled <br /> accardingly. <br /> 3, A file that is actively being worked on by END staff may not be immediately available for review. A now <br /> application may be wbmitte+d when the file is available. <br /> 4. Any file nvt returned In the same condition as cele,"ed will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by tate same applicant may require a S78.00 deposit prior to review. <br /> 5. *'TENTATIVE appointment dates must be oonflrmed wltfi SHb staff. <br /> s. Applications received after 3:00 pm will be processed the next bttsInOSS day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REN DATE <br /> 4.av ss ctlo'..�w <br /> TOTPL P.02 <br />