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ADDRESS SAN i -a lip UiN COUNT'i'PU13UC HEAsi iri . VVIRONMENTAL HEALTH ®IVISlt3 304 EAST WEBER AVENUE, THIRD FLOOR � C`J�C,� Iy�L� STOCKTON CA 95202 1r, (204) 466-3420 OCT11 02000 S IV RECORDS RELEASE APPLICATION -- I cS BUSINESSIAGENCY L(f),U'a4ce 05 - FACSIMILE TENTATIVE' APPOINTMENT DATE l 0"t4 -P-7 o TIME _ l?" (Please give 7 to 90 business days from date o$ applicatlon submittal)T R �t�� 1 les - CHECK BOX TO EXPEDITE klE - , 78.Q0 FEE - RE ST PI2QCESSED IN 3 BUSINESS DAYS Re—P-6 95pteS r—mm SIGNATURE OF APPLICANT DATE UNDERGROUND TANK (UST) CLEANUP SITE (LOP) OTHER CLEANUP SITE (NON -LOP) UNDERGROUND TANK. (MONITORINGIREMOVAL) HAZARDOUS WASTE GENERATOR ❑ TIERED PERMITTED FACILITY �LvtA ❑ TATTOO/BODYPEIKCING ❑ MEDICAL WASTE= FACILITY ❑ HOUSING AEJAT ENT ❑ SOLID WASTE FACILITY ❑ FOODACIL OG l 1 EL ❑ SOLID WASTE VEHICLE CI DAIRY ICK N RANC 3I ❑ PKG TREATMENT PLANT TEL INOTEL ❑ PLIMPER TRUCKIYARDICHEM TOILE -US p POOUSPA O PUBLIC WATER 'YSTEM O LAND USE APPLICATION SITCS 3F-FriC OTHER (PLEASE SPECIFY ABOvI) Uj ftLS lit I +� �•� I� ��t��—�1 � M � �at t % ��nJhr , • ra7f1'14.� �I�V7IS.�S6. t, � �!�/�li�i. �. firr' ; r1► .r, r . / f_ i+i�.�A��f:��i►'�•��!R�.Jg..r��. ...._. UNDERGROUND TANK (UST) CLEANUP SITE (LOP) OTHER CLEANUP SITE (NON -LOP) UNDERGROUND TANK. (MONITORINGIREMOVAL) HAZARDOUS WASTE GENERATOR ❑ TIERED PERMITTED FACILITY �LvtA ❑ TATTOO/BODYPEIKCING ❑ MEDICAL WASTE= FACILITY ❑ HOUSING AEJAT ENT ❑ SOLID WASTE FACILITY ❑ FOODACIL OG l 1 EL ❑ SOLID WASTE VEHICLE CI DAIRY ICK N RANC 3I ❑ PKG TREATMENT PLANT TEL INOTEL ❑ PLIMPER TRUCKIYARDICHEM TOILE -US p POOUSPA O PUBLIC WATER 'YSTEM O LAND USE APPLICATION SITCS 3F-FriC OTHER (PLEASE SPECIFY ABOvI) Uj ftLS 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one filo type MUST be selected. r, to 209 404-0138 or mail to the address indicated above. 2. EHD will notify the applicant If any ENR files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled" accordingly. 3. A file that is actively being worked on by EHID staff may not be Immediately available for review. A now application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the some applicant may require a $78.00 deposit prior to review. 5. "TENTATIVE appointment elates must be confirmed with EHD staff. 8. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPGINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EH 46 14 MOWN