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I <br /> SAi Q (N COUNTYPUBLIC HEALTH&RVIGES <br /> RONMENTAL HEALTH DIVIS� I <br /> S5F E <br /> B p 6 2 ti 4+ AST WEBER AVENUE;THIRD FLOOR y <br /> ?� STOCKTON CA 95202 <br /> �- 209 468-3420 ° <br /> PERMI•I"/SERVICES PUBLIC RECORDS RELEASE APPLICATION S _ <br /> APPLICANT DAVID VP QC-A<szezz-1� BUSINESS/AGENCY <br /> ADDRESS _P0, 0 2loS Vi,7,02 CAq.5d Glc1 � 1. <br /> PHONE -207 7SFACSIMILE Z� 3�9 X703 <br /> TENTATIVE*APPOINTMENT DATE TIME n i D <br /> )y <br /> (Please give 7 to 10 business days from date of application submitta <br /> 6 1rz <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE—R EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> hip Guns Fo ent ev �i4, W,4 57-e AV0VA-C. <br /> ENVIRONMENTAL HEALTH DIVISION FILES pR(Z 0x70�/ <br /> ❑ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEt ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail 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 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 /> accordingly. <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 same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> �n nt onr. <br />