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SAN JQQUIN COUN'1 YPUBLIC HEAL 1"HV iCks <br /> R s IVIRONMENTAL HEALTH DIVISIS <br /> 304 EAST WEBER AVENUE,THIRD FLOOR - oZ <br /> STOCKTON CA 95202 <br /> (208)468,3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT /�� M fMry BUsmss/AGENCY [.al�`l1�EP <br /> ADDRESS -7 Q J� SIJ L�11 �L� Q � t� �� J� .�r.,R fos` FM <br /> PHONE Q FACSIMILEtb CD <br /> f /I <br /> TENTATIVE"APPOINTMENT DATE r TIME p f r G+r_G." 1►►i Z <br /> (Pie==give 7 to 10 b sines days,from date of application submittal) �� Oo <br /> mC:==--� <br /> CHECK 8070 TO EXPEDITE REQU T-378.00 FEE—REQUE T RO ESSED IN 3 BUSINESS DAYS _ p <br /> SIGNATURE OF APPLICANT DATE <br /> { FILE ADDRESS <br /> ✓ 1 + UAiAiM <br /> 1 <br /> D S <br /> rl '71,rt r <br /> £ X303 <br /> ")5175- <br /> :5 ri d' La Aye 10 2 Cie, a 3 1 <br /> o Ltd <br /> i� <br /> . pe - no Pi Lt.$ ... U5-tie ivti0 ur' 68 •`R�7h tk * "8 SA e.Ro7K.1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) M HOUSIM13 ABATEMENT © 30LID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 13 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> d TIERED PERMITTED FACILITY d MOTELIHOTEL ❑ PUMPER TRUCKIYARPICHI=M TOILETS <br /> © TATTOOIBODY PEIRCING Q POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM yl A<OTHER PLHASE SPECIFY ABO <br /> WAAl-, is 50-Tic- vsQ <br /> 1. List up to ton addresses In the space above. Select the type(s)of files from the list hove by checking <br /> theappropriate box(es). At least one file type MIDST 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 days but no later than ten (10) days after receipt of application. The flleS <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 returned 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$78.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be corifirmed with EHD staff. <br /> S. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DACE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS . <br /> REVIEWED YES NO REVIEW DATE <br /> EH 09 44 01MMO <br />