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COLINTYPUBLIC HEALTi LRV10ES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br /> <br />_ma,acei Efivi_6Tm8iib Odet4 <br />r <br />--TrP1 <br />AFPLVGA.T1 <br />ADDRESS 23 <br />BUSINESS:AGENCY <br />PHONE al61 4/6/7 -/eO6 _ FACSIMILE ,R129- 9417 -11AL <br />CHECK BOX TO EXPEDITE REQUEST - S FETE — QUEST PROCESSED IN 3 BUSINESS DAYS <br />TENTATIVE" APPOINTMENT DATE TIME <br />(Please give 7 to 10 bu_siness days frnr7 data of application submittal) <br />L9A11/ 73- 3, Z <br />SIGNATURE OF APPLICANT <br />FILE ADDRESS <br />. • .11r,ef_ Iftort X , <br />I I r • I r . ... 5-.2./ <br />I • II., <br />'1IP <br />1 2.53_ ‘ <br />.1 • . IA • <br />VLOCAL I. . I MEM <br />Milliff ... , - .1 <br />I • i *. • Pri 41 • 5.5.2)0 <br />,,••• • I , litic . _ . r qi 4 a • '.9 6 ° <br />1-112D-AL-66, I • 0 4 I r (kV ' i N Astat_ : ' •• ' .1 0 <br />I <br />.4 _ <br />Vitt • ' • 16 , ...it • , <br />. <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />..*,UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />...12<UNDERGROUND TANK (MONITORINGIREMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />0 TIERED PERMITTED FAC/UTY <br />I-J TATTOO/BODY PEIRCING <br />MEDICAL WASTE FACILITY 111CIODEJOCI HOUSING ADATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTELIHOTEL <br />POOEJSPA <br />PUILILIC WATER SYSTEM EIRDDLI OD SOLID WASTE FACILITY <br />SOLID WASTE VEHICLE <br />DAIRY <br />PKG TREATMENT PLANT <br />PUMPER TRUCK/YARDICHEM TOILETS <br />LAND USE APPUGATION sn-Es <br />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 />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 />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 fire is available. <br />Any file not returned in the same condition as released will be reorganized by El-ID 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 />'TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED <br /> <br />PHONE FAX INITIALS <br /> <br />REVIEWED <br />-Di DO 14 01105)00 <br />YES NO REVIEW DATE <br />