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bATE RC40VEG <br />V PT, <br />SAh AQUIN COUNTYPUBLIC HEAL?ENVIRONMENTAL HEALTH DIVISION��-�� <br />30+4 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468.334.20 APR 0 7 2000 <br />PUBLIC RF—CORDS RELEASE APPLICATION, <br />t,�n�nn (rr. _iCAI TI_� <br />susinlsssrAGeNcY 4it3?'� PER M11 <br />-J <br />TENTATIVE— APPOINTMENT DATE TIME <br />(Ptesse Siva 7 to 10 business days Enam date of app4joatlon <br />CHECK BOX TO EXPEDITE REQUEST - $78.t14 FEE - REQUE5T PROCESSED W 3 BUSINF35 DAYS <br />. e DATE <br />SIGNATURE OF <br />ENVIRONMENTAL HEALTH UIVISION FIL <br />s.- <br />CS <br />e <br />APR 12 2000 <br />YMNDCAOROUND TANK (UST) CL@ANUP SISE (LDP) Q HOUSING ABATE=MENT SQLm WASTE FACILITY <br />THER CLEANUP SITE (MON-LOP) d FOOD FACILITY ///// D SOLID WASTE VEHICLE <br />NDEROROVND TANK (slONITORING(REMOVAL) O DOC' KENNEL 0 DAIRY <br />AZAA90US WASTE GENERATOR i7 CHICKEN RANCH 0 PKG TREATMENT PLANT <br />TIERED PERMrrMD FACILITY 0 MOTELINOTFI. ❑ PUMPER TRUCKIYARViCHEM TOILETS <br />O TATTCMWWDT PORCING LI POOLISPA 0 LAND USE APPLICATION SITES <br />0 MEDICRE WASTE FACILITY 0 PUBLIC WATER UY7STEM E3 OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ton addresses in the space above. Select the type(s) of files from the list above by Checking <br />the appropriate box(es). At least one file type MIDST be selected. Fax to (209) 4-0138 or mail to the, <br />adgre*s Indicated aboV®. <br />2. EHD will notify the applicant if any EHD files exlsL An appointment for review will be confirmed <br />approximately five business days but no later than ten (10) days after receipt of application. The files <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />aGuordi ngly. <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 sante condition as released will be rearganized by EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $78.00 depDsit prior to review_ <br />S. * TENTATIVE appointment dates must be confirmed with EHD staff. 4 <br />8. Applications received after 3:00 pm will be processed the next business day, <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INinIALS <br />REVIEWED YES NO REVIEW DATE <br />EM ao Iw 01ASM <br />TOTAL P.02 <br />