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11-14-� W;If-r-F9 rrnri iu '.:�lw('CJ0 r.a <br /> u.�i4 MYt:lJYE.o , I t w .J • t� `•/ •,x-� smLW W^V" <br /> sAN Jk,4UIN CaUN rYPUBUC HEALTH SLICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)466.3420 <br /> PIJBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT --stn a Pce F BUSMUWAGENCY Wojjta.rr�t- j<uj 11 1 ASSotra��"GS <br /> mwn s ,3G-E ��dc�sff`1Ol tvd_�S, �r rnuw � �. 9 rag <br /> PHONE FACSIMILE__qj <br /> TENTATIVE*APPpIkTs+" T RATE <br /> (Phase give 7 w 10 ;m"da a frau datoct pManUan subndtlal <br /> CHECK pOXTO ECAl5Dt'[8 REQUEST FEE-REQtIE37' IJSUV8S8 DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FItEs ADDRHSs •CHIS SEaE EFiF1 g rj FF use ONLY <br /> PRQGRAM NJOENrb,MARCH <br /> .104i-I'DOCAM RQ f0 Qk <br /> 3 . <br /> 40 <br /> ENVIRONMENTAL HEALTH OIVISIONI FILES <br /> W uNI ERGROURD TANK(UWQ GlkANUP SITE(LOP) C3 HOY$WG ABATEMENT 0 SOLID WAM FACtt-"Y <br /> ❑��tER CLEANUP SITE l�1NAM VEHICLE <br /> �uNOERG�ROUNDTANK(MCllit'rOIt GIREMOVALy O AOGKENHHL C2 PAMY <br /> CI HAZAR00US WAST@ SMARATOR d cIK3MN RANCH .13 PKO TRRATMElifr FLAW <br /> C3 TIERED PERMI17RD PA+CILrrY O MpTRjH0TEL O PUMPWTft 1CK1YAfWX" l TOS <br /> LI TATI`001 tODY PEIRCING O POOUSP4 ❑ LANCI USE APPLICATION UM <br /> O MEDICAL WASTE FAC J Y Q PUBLIC WAT9R SYSTEM O OTHER tztzASE SPECWY AROM <br /> �. List up to ten addresses In the space above, Select the type(s)of filet from the Nat above by chackha <br /> the appropriate bo*esj. At(east a no file type MUST be soiected. Fax_ t�f209)4644138 or mail to the <br /> 2. EMD will notify the applicant If any EHO files exisL An appointment for review will be confined <br /> approximately fire business days but no later than ten(10)days after raeeipt of appileativn.'•The Ries <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 la-ID staff may not be Immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any flimi not rsturne%I In the same condition as released will be reorganized toy Eiji)staff at the expense <br /> Of the ag13110ant. FUI: re file ravlews by the same applicant may regtdre a$87.00 deposit prior to review. <br /> 3- 'TENTATIVE appointment dates must be conflrmed With EHO stuff. <br /> B. Applications reeelved after 3:00 pm will be processed the next business day. <br /> PONFIRMED APPQimTMENT DATE TIFyIE <br /> DATE GONF7RIYILD PHONE FAX <br /> INITIALS <br /> RAY EWED YES NO REVIEW DATE <br /> ao t <br /> TOTRL P.Oi <br />