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� <br /> D�ER�BV� �mmo���� <br /> �� U �� �� � `� <br /> =��� ��������\� =����. " <br /> KnU�UVVh�U8 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0OUEast K8oin8LStockton. (�A952O2-3U29 <br /> MAY & 3 ` �� <br /> 010re1ephone: (209)408-3420 Fax: (309) 464-0138 Web: vmxmv. gov.orgAand—�� c� -0 3 w� <br /> �NV|� TA��|TA PUBLIC ������������ RELEASE APPLICATION <br /> _..' �___. . . .^'`�.. . . .~~~.—..~ RECORDS . ..—.—~~. .,~~~ <br /> ",,LIC"... <br /> ADDRESS: <br /> PHONE (i): PHONE (2) FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX ToEXPEDITE REQUEST s11nFEE(CASH onCHECK ONLY) REQUEST PROCESSED|wnBUSINESS DAYS <br /> SIG6TUIRE OF APPLICANT DATE <br /> Electronic Information: E] List Fj Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name city I C—E]unit I <br /> 2. <br /> 3. <br /> V, <br /> 9. <br /> 10. Uni <br /> Specific Date Range mInformation Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LDP) El HOUSING ABATEMENT SOLID WASTE FAmLn,msmnLs <br /> OTHER CLEANUP SITE(Now'LDP) FOOD FACILITY WASTE TIRE <br /> UNDERGROUND TANK(Mnwnomwo/RemowvUEl DOG KENNEL 0 QwnY 0'1��� <br /> HAmmmouoWASTE GENERATOR»^ CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> T|snsuPsRMn7soF*n|Lnm—L MnrsUHorEL PUMPER Tnuo�YAnoC*smmxLTmLsTo <br /> Tmroo8]onrP/swc/wo vPooUSpx ——LANoUosAppuoxTIowSnso <br /> LJ MEDICAL WASTE FACILITY LJOTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RF 00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the typo(n)offiles from the list above bychecking the appropriate <br /> box(es). Atleast one file type MUST bmselected. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:0Opmwill beprocessed the next business day. <br /> 2. The EHDwill notify the applicant ifany EHD files exist. &nappointment for review will bmconfirmed approximately ten(1O) <br /> days after receipt mfapplication. The files will haheld for mmaximum offive business days for review. Appointments <br /> should bescheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew application may be <br /> submitted when the file imavailable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> 5. |fyou need further assistance,please contact Diane Martinez,ot(3u9)468'3425. <br />