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A, 23 �OUI 13G,'Pi�I C'iuOF, E +h'iH TECHPi0L0ulES hla• 6i � F' 1 <br /> MATZ A.' SIVEU - j --) 11 LGG NUNBEA <br /> -- --'SAN A DQUIN COUNTYPUBLIC HEALTH &VICES <br /> o� ENVIRONMENTAL HEALTH JDIVISION <br /> '�u 2 2001 304 EAST WEBER AVENUE,THIRD FLOOR'� i STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS REI-EASE APPLICATION <br /> APPLICANT KAd.r aUSNES (AGENCY CO"OI.Or �a r �K �•zc live s�lv i aS tea.c. <br /> ADDRESS f�S �rct vi k �lzs � sii►rctz �je-i �� T— ti S <br /> PHOuE 2.011 - 2 3� - os-f 8 FAcsimiLE 20 - 23-4 <br /> TENTATIVE*APPOINTMENT DATE SL I -ori 1 �I� 8=3 0A � <br /> (Please give T W rt6business days from date of app3c4on submittal} <br /> C3UNIT5 3, Z/ <br /> CHECK BOX TO EXPEDITE REQUEST-$81.00 PEE,REQU ST 119CESSLN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE L9 23-4:1 <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> `- PROGRAM ELEMENTS SEARCH <br /> I IA S �`` '�'oY► <br /> E l hA <br /> 12-a e _ <br /> so <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(LIST)CL5ANUP SITE(LOP) 0 HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> ;OTHER CLEANUP SITE(NON-.OP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> W'PNDERGROUND TANK(MONITORINGIREMOVAL) 0 006 KENNEL. 17 DAIRY <br /> L/"HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATLW-NT PLANT <br /> © TIERED PF-1 1TTTED FACILITY 0 MOTE MOTEL _ ❑ PUMPER TRUMYARWCHF-U TOILETS <br /> ❑ JAITCUSODY PEIRCiNG ❑ POc)I1SPA ` ❑ LAND usr APPLICATION SPIES <br /> GY MEDICAL WASTE FAGIUTY ❑ PUBLIC WATER SYSTEM 0 OTHtR(PLEASE SPECIFY ABOVE) <br /> 1. List 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 selected. Fax to (209)464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business clays 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 on 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 raturned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHO staff. <br /> E_ 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 />