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j <br /> SAN a , ekQUIN COUNTYPUBLIC HEALTH $EmVICES `^ � <br /> 1 i )a1 \ / <br /> <_JJl ENVIRONMENTAL HEALTH DIVISION Ita SLE L, � <br /> cI304 EA$T WEBER AVENUE, THIRD FLOOR I �_ ��= �a <br /> '!7 g <br /> J _ STOCKTON CA 95202 ' <br /> V -1 (249) 468-3420 � �y �il+l� <br /> r5 y PUBLIIC RECORDS RELEASE APPLICATION <br /> 1 nk � .CV r H <br /> APPLICANT <br /> ADDRESS <br /> �,t1 / 1 C fes. rte <br /> PHONEIZ� FACUMILE _ `I ) ( � • i/ <br /> TENTATIVE- APPOUCTMENT <br /> DATE T[NE <br /> EPfscso &� f � �0L Vsineas days tram tlate of application sutmitmr) <br /> © CHECK BOX To EXPEDnE REQUEST - S7&00 FEE — REQI)EST PROCESSED N 3 8W INESS DAYS <br /> SIGNATURE OF APPLICANT DATE ©® <br /> FILE ADDRESS - <br /> r4ViAr. <br /> c, J n <br /> r <br /> ' R ..�. •:yy A W <br /> ENVIRONMENTAL HEALTH DI Vi5fON FILES <br /> ;�F1NVERGROUND TANS Iu`-r) CLEANUP SITE p.OP) ❑ nOUSiNG ABATEMENT ATEMT ❑ SOUD WASTE FACILRY <br /> �THFst CLEANUP 517E (NDN-LOP) C FOOD FACILn7 ❑ $OLID WASTt VEHICLE <br /> ERGROUND TANK (M0MTORLNQAVA4OVAL) ❑ VW KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENE•RATQR O CHICKEN RANCH ❑ pKG TREATMENT PLANT <br /> ❑ YIERED PERMITTED FACILITY ❑ MQIEUHOTEL ❑ PUMPER TRUCKfYARWCHZN TOILETS <br /> ❑J TATTQ0I5O0YPELRCING ❑ POOLISPA Cl LAND USE APFLICAT)ON SITES <br /> ip TAEWAL WASTE FACILITY ❑ PU8UU WATER 3YS7EM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> j f • List up to ten addresses in the space above. Select the typo(s) of files from the list above by checking <br /> Me appropriate box(es). At least one file type MUST be selacted. Fax tQ-(209) 464-Q13a or merit to the <br /> address indicated above <br />! 2. EHD Will notify the applicant if any EHD files moist_ An appointment for review Will be confirmed <br /> apprOXimataly five business days but no later than tcn (10) days after receipt of application. The fifes <br /> Will be held fora maximum of five business days for review. Appointments shdUW be scheduled <br /> waordingiy. F <br /> 3- A file that is actively being worked on by EH13 staff may not be immetsatety available for reviM. A new <br /> application may be submitted whOn the file is available. <br /> 4. Any file not r6btrnmi in the same condition as released will be reorganized by EHD staff at the exponse <br /> Of the applicant Futuro file reviews by the same appliCaflt may require a $78.00 deppsit prior to rr V% e . <br /> 5. `TENTATIVE appeintnlent datOS must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 Pm will be processed the next bhsiness day, <br /> CONFIRMED APPOINTp16NT DATE TIME <br /> DATE CONFIRMED PHQ1IE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE — <br /> TOTAL P . 02 <br />