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SAi\I �QUIN COUNTYPUSLIC HEALTH VICES <br /> L-1-4VIRONMENTAL HEALTH pI1rISl:.�. <br /> � i-S <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202. — <br /> S J J L 2 3 Z001 (249)468-3420 <br /> y PUBLIC RECORDS RELEASE APPLICATION <br /> I1 <br /> AP 667I!Qai r i w`lfJ, BUSINESSIAGENCY GI� UA& lJ��,J (�l�U9 Q( / c <br /> RE <br /> ADDSS 4 <br /> N <br /> � �/ t1��4V �L X �det4/L <br /> -1 <br /> PHONE A2 -/00& —FACSIMILE a q- y/0 7' 1 'y <br /> _---►`. <br /> TENTATIVE'APPOINTMENT DATE SOD V%- _ TILIE <br /> (Piease Sive T to 10 business days fra data of appticatlon submittal} <br /> K'CHECK SOX.TO EXPEDITE REQUEST-$ _ 0 F QUE T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE CSF APPLICANT - DATE Z O 1 <br /> FILE A00IXS5 <br /> F . o <br /> � FIL <br /> � <br /> 3 <br /> 1AIr WWIA <br /> L <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROLIND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 5OUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORINQIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> 4<HAZAR00US WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL Q PUMPER TRUCIUYARDICHEM TOILETS <br /> 0 TATTOOIBODY,PEIRCING ❑ POOLISPA ❑ LANE)USE APPLICATION Sn'ES <br /> Q MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ QTHER(PLEASE SPECIFY ABOVE) <br /> .a <br /> 1. List tip 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. FItx to (249) 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 recolpt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scfteduted <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 filo is available, <br /> 4. Any file not retumed in the same condition as released will be reorganized by EHQ staff at the expense <br /> of the applicant. Future"file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:04 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 /> E}I 0014 DUDWO <br /> .d <br />