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/ SAN ")AQUIN CDUNTYPUSUC HEALTH '"'RViCES <br /> J HEALTH DIVIS <br /> ENVIRONMENTAL H ..,,( <br /> hj � <br /> �J ei 304 EAST WESER AVENUE,THIRD FLOOR STOCKTON CA 95202 �� <br /> l (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A KESS _ <br /> HONE o _ FACSIMILE <br /> TEATIVE"APPOINTMENT DATE � r" S u TIME 11jj � ��i'.!'`ii riV': �11Li�i <br /> {Please$lye 7-- buslnerb days from date of appticatlan submittal) y. <<'.: �' <br /> r;-T1u' : , FS <br /> �-lkviTS 3. � x` �j�� J�attf <br /> XCHEICK 13OX TO F-XPEDITP RERU -578-00 FEE_REQ ST P OCE SEP IN 3 8USINE5S DAYS Lf• ,> <br /> SIGNATURE OF APPLICANT DATE Q <br /> FILE AD6I4ESs <br /> d Ing <br /> aye o0/Z!H <br /> Cf1d AA :r <br /> t ,t , , „ — <br /> jb"►She 1'l U ............. <br /> ENVIRONMENTAL HEALTH DM-510N FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING A13ATEPAENT 0 SOLID WASTE FACILITY <br /> flTHEII CLEANUP SITE 0YON-LDP) Q FOOD FACILITY ❑ SOUD WASTE VFWCI.E <br /> UNDERGROUND TANK(MONITORINGtREMOVAL) M DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PEACMITTED FACILITY 0 MOTELIHOTEL [D PUMPER TRUCKlYARnicHEM TOILETS <br /> CI TATTOO/BODY PEiRCING b POOLISPA ❑ LAND US5 APPLICATION SMEs <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WA'T'ER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I t.ist up to ten 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 select4d. Fax to (209)464-0'l38 or matt to_the <br /> addr s1ndica d above. <br /> 2• END will notify the applicant if any END files exist An appointment for review will be confirmed <br /> approximately five busina3s days but no later than ten(10)days after receipt of application. The files <br /> will be meld for a maximum;of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not bo Immediately availablefor review. Anew <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 F-HD staff at the expenSe <br /> of the applicant, Fttture'fiie reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5• 'TENTATIVE appointment dates must be confirmed with FID staff. <br /> 6. Applications received after 3.00 pm will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> RlrV11=WED YE5 NQ REVIEW DATE —�� <br /> FH w t7 atroe+ho ' <br />