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SAN QUIN COUNTYPUBLIC HEALTH VICES <br />[b) (=NVIR+�3NIVIENiAL N ►L7H I�IVISI <br />--� �` << - 304 EAST WELDER AVENUE, THIRD FLOOR <br />fl7 STOCKTON CA 952132. <br />S <br />AL L 2 3 2 0 01 (2013) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLFtrAN71 i <br />[CA ,>1 11,r <br />57/ <br />TENTATIVE' APPOINTMENT MATE 1.000 V\. TIDE <br />(Please Sive 7 to 10 business days fro data of application submittao N <br />CHECK BOX TO EXPEDITE REQUEST - S _ D F QUEST PROCESSED IN 3 BL13INESS DAYS <br />SIGNATURE OF APF UCANT _ DATE 2S 1V&4 O I <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) tLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLO WASTE FACILITY <br />4OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINUIREMOVAL) Q DOG KENNEL ❑ DAIRY <br />HAZAADOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br />❑ TIERED PERMIT FD FACILITY ❑ MOTE1HCFM ❑ PUMPER TRUCiQYARDICHEIA TOILETS <br />❑ TATTOOIBODY-MIRCING ❑ POOLJSPA Q LAND USE APPLICATION SITES <br />0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM n QTHE,R (PLEASE SPECIFY ABOVE) <br />11. List ap to ten addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate boxes). At least one file type MUST be selected. Fax to (249) 464-0138 or mail to The <br />address'lndlcated above. <br />2. EHD will notify the applicant If any END files exist. An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after racelpt 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 returned in the same condition a$ released will be reorganized by EHD staff at the expense <br />of the applicant. f=uture'file reviews by the same applicant may require a $78.00 deposit prior to review. <br />S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. 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 />REVIEWED YES NO REVIEW DATE <br />EM 00 14 DIMS101) <br />