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JUN-01-20Gt[ 1-5:-24 1.UJOEVAP.P-CL`r'CE --0''1'SULTi41- 5110 874 O2,bB F'.FI/C1 <br /> } ZZ.)J-kN IkkAUIN I61VLJI1 l I YUDLIL rICI1Li n .--R V I�.lrJ <br /> _> 1NVIRONMENTAL HEALTH DIVIS. <br /> 30.4 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 469-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> lAP?LIGANT 1 �1r B SINESS;AGENCY <br /> 1 <br /> fADDRESS C1i <br /> P>iONE f f''��1 1 L] t c FACSIMILE <br /> TENTATIVE'APPOINTNtE,NTPATE 06 &)'Joo T1ME !0'3D { <br /> (FIeare give 7 to 10 b 6z in4js dsya frpm date of application submittal) <br /> QCME:;K SOXTti EXPPnITF REQUE 8.D0 FEE—REIUEST 11ROCE53ED IN 3 BUSL`IESS DAYS <br /> SIGNATURE OF APPLICANT DATE �D0 . <br /> FILE ADDRESS ILF THIS SIDE EHD STAFF USE ONLY I <br /> i <br /> 7`j VE PROGRAM{ELEMI`NYS SEARCH <br /> 5t 6U5 t4 1313E et++9--GX C.JMf <br /> 7 S W'L6-Aa WO-w a- <br /> 2 50 S, 41�L 5011 •2 <br /> �aTiaa K�-r F• !a S W. on1 �• <br /> 7V6 L41N E14 SI Etd0-4 IJE'Vhh4 <br /> TING D W{G5-" I <br /> 1'0 GLIA 1 _ S. t LSa N lel I. <br /> frJ eRJG 45';;k 5 W94-3er•4 W ► <br /> ' .j�EhITA{,1•�('rH•t N✓r' C.o . l�a f �+•a-2r-�-a�.. t, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> '•,A UNDERGROUND TANK LUST)CLEANUP SITE(LOP) M HOUSING ABATEMENT ❑ SOLID WASTE FACIL.,TY <br /> ;•i® OTHER CLEANUP SITE(N4rt-t,OP) ❑ FOOD FACILITY Q SOLID WASTE VEWCLE <br /> U14DEAC.RQUND TANK[.KONITOWNWREMQVA,I G DOG KENNEL Q DAIRY <br /> L HPZa.?LO+IS YJ42;TF GENERATOR D CHICKEN PIANCH Cl PKG MATMENT PLANT <br /> 1❑ T&REt D;FRr,tiPT:i1CI MOTELIHQTFL- ❑ PUMPFFtTRUCKIYARDtCHEMTOILETS <br /> +' Y. T ❑ POCLISPA t7 LAND USE APPLICATION SITE5 <br /> +C� .'•SWIG-L '.V,'.S•'i c: '.'.".1LlT'! C PUH LIG WATER SYSTEM E3 0THFR 5PECIFY ABOVE) <br /> 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 t01209)464-0138 or mail to the <br /> j Zddress indicated a Ove. <br /> EHD will notify the app;icant if any EHD files exist_ An appointment for review will be confirmed <br /> appraxirnatcly five business days but no later than ten(10)days aftorreceipt 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 tVat 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 rol eased will be reorganlxed by EHD 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. ITENTA71VE appointment dates must be confirmed with EHD staff. <br /> 6. Applications receiveo after 1.00 pm will be praCessed the next business day. <br /> f <br /> t CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED PHONE FAX INITWLS <br /> REVIEtiYED YES NO REVIEW DATE <br /> >� ao is o�nuw <br /> T+3T::L F.0= <br /> TOTAL P.02 <br />