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SAN -ICAQUIN COUNTYPUeLIC HEALTH SS FRVICES <br /> UENVIRO394 EASSTtW 5ER AVENMENTAL UE,TTHIRD FLOOTH R ,j k <br /> STOCKTON CA 95202 -" <br /> (209)488-3420 <br /> PUBLIC[RECORDS RELEASE APPLICATION <br /> APPUCAMT[��rA�-✓`/'J LEE SUSINESSIAGENCY hC <br /> AIyDREss b l s? L[i[a <br /> Cie-" <br /> - <br /> PHONE FACSIMILE <br /> TEHTATIvE"APPOINTMENT DATE TIME <br /> {Please give 7 to iu businass days fmm of ap ication aubmif[al) <br /> Q CHECK BOX70 s=7tl'1r13CT1=REgUEB -S 00 FEE r5T ptmOCi 55E:V IN 3 OU51NES5 DAYS <br /> SIGNATURE OF APPLICANTF3AI"� � f �1 <br /> I <br /> - I <br /> FILE ADDRESS <br /> oArinna. V 35, 2 <br /> I - <br /> 35 29 <br /> r <br /> ENVIRONMENTAL.HEALTH DIVISION FILES <br /> UNDERGROUND TANKJUST}CLEANUP SITE(LOP) 0 HQUSING ABATEMENT U SOLID WASTE FACILITY <br /> . q OTHER CLEANUP SITE(MON-L QP) FaOD FACILITY Sl7L1D WASTIw VEHICLE <br /> UNDERGROUND TANK tMONITORIHGIR€MOVAL) 0 DOG KENNEL ❑ INAIRY <br /> HAZARDOUS WAM GENERATOR t] CHICKEN RANCH 0 FKO TREATMENT PLANT <br /> Q TIERED PERMITTED FACILJTY 13 Moor-LIHOTEL. M pUmpER TRUCKrfAltt1lCHI=-M TOILETS <br /> I7 TATTOOfBoDY PiimcimG tl POOLJSPA II LAND USI=APPLICATION 5rMS <br /> 0 mEDICAL.WASTE FACILITY 0 PUEILIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. 5elsct the type(x)of files from the list above lay Chficking <br /> the appropriate 4OX(es). At least one fife type MUST be selected. FgX to 209 464-0133 or mail to th <br /> address indicated above. <br /> 2. EMU will notify the appficant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bus Ines s days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business clays for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A talq 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. Anylle rnot returned in the same candAlorl as released will be rearganiied by ENI]staff at the expense <br /> of the applicant. FuturFuJile reviews by the same applicant may require a$73,DD deposit prior to review. <br /> 5. -TENTATIVE appointment states must be continued with EHD staff. <br /> 6. Applications received atter 3:00 pm will be processed the[Text business day- <br /> CONFI.RMF-6 APPOINTMENT DATE TIME _ <br /> DATE CONFIRMED PHONIC FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE -- <br /> FN no otdim <br /> f <br /> If <br />