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�A�� J I/� (�{�U/�TYpU��L](� }�E��LTH �(�E�� u~*^u«u�u^ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR H yUoj 804 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCK3ON CA 95202 <br /> (209) 468-3420 ' <br /> �[��!n��H� ES PUBLIC RECORDS ��E/ EASE APPLICATION <br /> �J <br /> APPLICANT 64RK -------'--'-' <br /> ADDRESS <br /> pxOws pxCsim|Ls <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give 7to10business days from date ofapplication submittal) <br /> F7 CHECK BOX TO EXP`E�ITE REQUEST-$87.00 F R S ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Uzy <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> u <br /> UNDERGROUND TANK(usT)CLEANUP SITE(Lop) o HOUSING ABATEMENT SOLID WASTE pxc|uTY <br /> o OTHER CLEANUP SITE(NON'LOP) o FOOD FACILITY Ob SOLID WASTE VEHICLE ` <br /> O UNDERGROUND TANK(Mow}TOm}wG/nsmOvxL) 0 DOG KswwsL o omuY <br /> o HAZARDOUS WASTE GENERATOR o CHICKEN RANCH o puGTREATMENT PLANT <br /> o TIERED PERMITTED FACILITY o MoTsuxoTcL o PUMPER TRucx/nxuo/onsmTOILETS <br /> C3 TxTrocxnooYps|no|wa o PoouspA ' ' o LAND USE APPLICATION SITES <br /> o MEDICAL WASTE FACILITY o PUBLIC WATER SYSTEM o OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List uptoten addresses inthe space above. Select the typo(u) offiles from the list above bychecking <br /> the appropriate box(es). Atleast one file type MUST beselected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHDwill notify the applicant ifany EHDfiles exist. /\nappointment for review will boconfirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. /\file that is actively being worked on by EHD staff may not be immediately available for review. Anaxv <br /> application may besubmitted when the file isavailable. <br /> 4. Any file not returned_inthe sanoauongiUunasreleased xxil| boreorganized byEHOstaff atthe expense <br /> ofthe applicant. Futurafile reviews bythe same applicant may require a $87.O0deposit prior toraviom/ <br /> 5. *TENTATIVE appointment must confirmed E8O staff. <br /> ' <br /> nn <br /> O. Applications received after 3:UUprnwill bmprocessed the next business day. <br />