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DATE flLCk1YED 010 LDV NUMgF.R <br /> SAN JO - QUIN OOUNTYPU13LIC HEALTH ` RVICF_S <br /> XlRONMENTAL HEALTH DIVISIL / <br /> 304 EAST WEBER AVENUE, THIRD FLOOR C/� <br /> STOCKTON CA 95202 <br /> (209) 46$-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT Mn.ri u4w. S HU$RIESSIAGENCY <br /> ADDRESS1g Ir. ic W -F 4rrtlu �,k.: {-n_ �` � {w41.�•t-off { LA 9520 !d <br /> PHONE2- x✓'y, - LOBI i:'j FACSWIL.E <br /> � O• r <br /> TENTATIVE' APPOINTMENT DATE nµE <br /> (Please give 7 to 10 bu kWj5S days from dater of applicatiub, l)on c, <br /> days a3 <br /> Q CHECK 130X TO EXPEDITE REQUES�,T m $87aOB FEE — REQUEST' ROCFSSED IN aUSINE36 DAYS <br /> SIGNATURE OF APPLICANT .±Z DATE 2. o--o t <br /> FiL.EADDRESS - TFNS Slgg EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> oa Jo <br /> ro sr. 3� yw <br /> 526 J.j , 'Sa how q,u i�. $•1', _ �� <br /> G20 fel1 . �CjC a... ,Y7o c•, ; n S-t <br /> ENVIRONMENTAL HEALTH DIVISION FILA~$ <br /> nNDFRGROUND -rANK (UST) CLEMUPSfl-t (LOP) ❑ HOUSING ABATEMENT &'SOLJDWASTE FACILITY <br /> C•T PTNER aLEANUPSITE (NOWLOP) Q FOOD FACI4RY SKSOUD WASTE VEHICLE <br /> fir UNDERG ROUND TANK (YONITORING(REMOVAL) 0 DOG KENNEL U DAIRY <br /> I3'HAZARDOUS WASTE GENERATOR 0 CUnMN RANCH ❑ PKG TREATMENT PLANT <br /> Q TIERED PERMITrFD FACILITY Q MOTCLIHOTEL 17 PUMPEIt TRUCKIYARDlCHEh1TORETS <br /> LT TATTOO/eODY PEIR0WG u pwilsPA - • rT LANn USE APPIJCATTON srrF_s <br /> I IMFIIICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY A13OW) <br /> 1 . List up to tan addresses in the space above. Select 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 !2091 4fy1-0138 or mail tom <br /> address indult@ att0Ve, <br /> 2. EHD will ,pottfy the applicant if any EHD 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 maximum of five business days for review_ Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked an 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 file not returned in the same condition as released will be reorganized by EHU staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit priorta review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EMO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE � TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />