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91/28/2002 13:29 209457? } AGE STUCKTGhf. rHu� u ;U1 <br /> pAT6 t2FCerveo eHv LOG NUMSER <br /> JQUIN GIaU TYPUBLIC HEALTH SW ICES <br /> ENVIRONME TAL HEALTH DIVISION ': Y <br /> 1 <br /> 304 EAST WEB R AVENUE,THIRD : <br /> e 1Z:5 l STO KTON CA 95202 <br /> Zb ( 09)468-3420 Z/ <br /> 42�A PUBLIC RECORD RELEASE APPLICATION;,m. <br /> APPLICANT C b.1VI 9USIN SSlAGENCY toFaLilhmgda <br /> AVEIRESS Uj 6ry f <br /> PHO (�� FACSIMILE: <br /> ENTATNE*APPOINTMENT DATE TIME <br /> (Please glva 7 to 10 busine days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.S7 0 FEE—RED E5T PROCE SED IN 3 BUSIN553 DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FI EADDRESS <br /> i <br /> 3S� <br /> S Z'7 M L ` <br /> S SS <br /> yS <br /> Zl- 55 <br /> i <br /> ENVIRONMENT L HEALTH DIVISION FILES <br /> IUNDF-RGROUND TANK(U5T)CLEANUP SITE(LOP) ❑ HO SING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DO KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHI KEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERE13 PERMITTED FACILITY O MO LIHOTEL © PUMPER 7RUCKIYARDICHEM•TOILETS <br /> Q TATTOOIBODY PEIRCING ❑ P LISPA ' . . E7 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 13 PU LIG WATER SYSTEM 0 .OTHER(PLEASE SPECIFY ABOVE) I <br /> 1. List up to ten addresses in the space abo e. Select the types) of files from the�'list above by Ctieirking <br /> the appropriate box(es). At least one file ype MUST be selected. Fax to 09)'464-0138 or mail to the <br /> address indicated above.. <br /> 2. EHD will notify the applicant..if any EHD fi es exist. An appointment for review.will be confirmed <br /> approximately live business days but no ater than ten (10)days after receipt of application. The flies <br /> will be held for a maximum of five busine s days for review. Appointments should be schrl:duied <br /> accordingly. <br /> 3. A file that is actively being worked on by HD staff may not be immediately available for review. Anew <br /> application may be submitted when the fil a is available. <br /> 4. Any file not returned in the same COnditio i as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by th i same applicant may require a$78.0@ deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be. onfirmed with EHD staff. <br /> 6. Applications received.after 3:00 pm will be processed the next business day. 4 <br /> j. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> eH as U 014CU o <br />