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03/U5/20U4 16:E28 FAX <br />f <br />\ DATE RECQyED <br />vA <br />MAR ®8 204 <br />a <br />I <br />209 9480621 <br />Wv Qe . <br />ENVIRONMENTAL DIVISION <br />0. EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON <br />(209) 468,U20 <br />PUBLIC RECORDS RELEASE APPLICATION <br />/ lev i <br />y5��� J3ys- FACSIMILE Zdq- 9y8- 006.el <br />TENTATIVE" APPOINTMENT DATE 3• /�0' <br />TIME <br />(Please ®Ivp 7 to 10 businesom data of application submittal) <br />• <br />CHECK BO TO ExpEDn-E REQUEST -M7 00 FEE- REQ ST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURI; 0k APPLICANT _ DATE SD <br />i9l 001/00 <br />&M LOG NUMBER <br />"i <br />PHIS SIDE EHD STAFF USE ONL` <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DMSION FILE <br />S <br />Imo' UNDERGRoutyD TANK (UST) CLEANUP srm (Lop) L3 HOUSING ABATEMENT C3G' OTHER CLEANUP SITE (NON -LOP) ' ® FOOD FACtury O <br />2f UNOERGROVND TANK (MONITORING/REMOYAL) D DOG KENNEL O <br />Q HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH <br />13TIERED PERMITTED FACILITY CI MOTEUHOTEL 0 <br />® TATTO0/80DY, PEIRCING C3 •POOLISPA ' . - 13' <br />® MEDICAL WASTE FACILITY ® PUBLIC WATER SYSTEM ❑ <br />SOLID WASTE FACILnR� <br />SOLID WASTE VFIi1CLE <br />DAIRY <br />PKG TREATMENT PLANT <br />PUMPER TRUCKfYARD1CH>=M TOILETS <br />LAND USE APPLICATION SITES ' <br />OTHER (PLEASE SPECIFY ABOVE) <br />1. List up to ten addresses in the space above. Select the type(s) of.files from the list above by checkin( <br />the appropriate box(es). At least one file type MUST be selected. Fax_ 01209) 464-0138 of mal(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 flue business days but no later than ten (10) days after receipt of. application. The files <br />will b� held for a maximum of five business days for review. Appointments should be scheduled <br />acc0 dingly. <br />3• A fllelthat is actively being worked on by EHD staff -may not be immediately available for review. A ne, <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 expens <br />of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to reviee <br />5. <br />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Appiatlons received after 3:00 pm will be processed the next business day. <br />r <br />I <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />