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(nG-03 7 <br /> SAPOAQUIN COUNTYPUBLIC HEALTHOSERVICES Inc <br /> (ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 a <br /> {209)458-3424 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A. <br /> ANT -4fAIQ` QE <br /> c52 1Q��rQ.cf✓.4tas �!/.4�f _�� DssK!' � 954,?'->�:s-.slaz.+iq{�'z <br /> FACSIMILE_ <br /> TENTATIVE'APPOINTMENT DATE TIIeE <br /> i <br /> (PiPase yivr/19 TO business days from date of spplicaitbn subminal) <br /> ECK BOX To EXPEDiTP REQUEST-;18,00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> 8 },TURE OF APPLICANT _ C- i ��C�r DATE �ee <br /> FILE ADDRESS <br /> Zor-ACW4 /50 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> ERGROUND TANK(UST)CLEANUP SFTE(LOC) ❑ HOUSING ABATEMENT ❑ SOUL)WASTE FACILITY <br /> ER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY D SOUL)WASTE VEMICLF <br /> SRGROUND TANK(NONTTORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> QUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> ED PEFUdn7E0 FACILITY E7 M07EV1407EL ❑ PUMPHRTRUCKrYAROXIIEUTOILETS <br /> 00/80DY PEIRCING ❑ POOLISPA CI LAND USE APPLICATION e(TEa <br /> <C'} WAL WASTE FACILITY n PUBLIC WATER am Em In OTHER(PLEASE SPECIFY ASOVR) <br /> i List up to ten addresses In the space above, Select Me type(a) of filaa from the list above by checki% <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 120&1 4fvf:2188 or mail to th3 <br /> addrass indirlited above. <br /> F EHD will notify the applicant if any EHD files exist. An appointment for review willbe confirmed <br /> approximataly five business days but no later than ten(10)day* after receipt 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 no, <br /> appilcation may be submitted when the file is available. <br /> 4 Any Tile not r$turnod In the same condition as released will be reorganl2ed by I!HD staff at the expens <br /> y of the applicant. Future file reviews by the same applicant may rmquirs a $78.00 deposit prior to royW <br /> 5' 'TENTATIVE appointment dates must be aoriffirmed with PhD staff. <br /> 13 Applicadona received after 3:00 pm will be processed the next business day. <br /> e <br /> IRMED APPOINTMENT DATE _ TIME <br /> {a CONFIRMED PHONE FAX INITIALS <br /> .!F En YES NO REVIEW DATE <br />