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SAN,'- `UIN COUNT`iPUBLIC HEALTH SERs <br />.JIRONMENTAL. HEALTH DIVISION <br />/ 334 F-ASTWEBERAVENUE, THIRD FLOOR <br />STOCKTON CA 95202 ClJ <br />(208) 468,3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APp1:scArrl' l t_ � ��BUS ?UT_ INE;S IAGENG-,y-(.�. �NoCo(�tb f --- <br />ADDRESS H� W& -T C(Rc c..b `,.X -1.. `f 'StLCk ed G _ <br />PHONE � psi 'I, FACSIMILE <br />TENTATIVE, APPOINTMENT DATE TUdj� <br />(PIC tit 9lVk 7 fQ 10 1JLLS1r()8S dors hom dato of appltcntiori su mttixl) <br />`—' CHECK SQX T`a L-:xPa0ITE REQUEST . saT.O F" - REQUEST PROCESS D IPI J eU•SIA"S C)AYS o c I 19 <br />s1GNATufil= OF Af'PUCAPtT DATE o 18 V <br />— <br />FiLE AGDi ESS 7915 3IDE EHD STAFF U OnLY <br />PROGRAM FLEMEN7S SEAACH <br />V <br />ENVIRONMt NIAL HEALTH DIVISION FILES <br />1J1g0rR0R0Ut4D TANK (U-Sn CLEANUP SITE (I.OP) 0 Ii0U3JNGA6ATfA1EM' X SOLID VIIASTE FACIUTY <br />jrtt OTHER CLEANQP SITF NON -LOP) Q FOW FACILITY O 5000 WASTE VEHICLE <br />JtiFiERGFtO11Nt? TAHK (MONITOKWC.,'RI:MOYALj 0 V06, K"NEL *cwpty <br />,$;8C KA.ZARDOUB; WASTE OrNtRATOR kf,GHZKP-N RANGK U PKC# TREA:TMENTPLANT <br />C] TIERED PERMITTED FACIUTY 0 l MLfHOTEL 0 PUMPER TRUCK(YARDoCHI;M TG`ILETS <br />❑ -TA,TTDA+NODY PMCINU D POOL15PA O LAN!❑ USF -APPLICATION SITES <br />Ar- MZ=At. WASTE FACILITY ❑ PUBLIC, WATER SY!$TEM 0 UTTER (f'L=ASE SPECIFY AGME;I <br />1. List up to ten addrasscs In the space rab4Ye. 9eloct iha typa(s) of f3lea from tits II -$t 4bove by Mecking <br />the, appraprlate box(es), At least une file typa MIJ$T be saWotad. Fax to (249} 464 0136 r mail o tf <br />address IndiCate!j ijW2ye- <br />2. EHD will notify thu applicant if any EHp fcl4s exist. An appointment for rcvjsw will be connrrned <br />appraxinTately five buslne" days but no later than ten (10) days after roc91pt of applic-alien. Tho files <br />Will be held for a maximum of five qusine$so days for review. AppointmentY ShOUld he schedulad <br />accordingly. <br />3. A file tial is actively heing wvrkod on by EHD staff may not be immediately awdlable for review. A new <br />a;ppli000A may be submitted when the Tito Is avaliRWe. <br />'t. Any file nut returned in the :tamQ ConCiitiOn as rel4: s8tr Will by reorganized by EHD Atbff at tht expense <br />of the applicant. Future filo review$ by the Same applicant may require a $97.00 deposit prior to rcvlew. <br />5. `TENTATIVE appoIntmiml dales must be COnfirrAed with EHD staff_ <br />6. Ap)(ica,flons received after 3.00 pm will be processed the next btiriness day. <br />CONFIRMED APPOINTMENT DATE TIME <br />[DATE CONFIRMED PHQNE FAX INITIALS <br />REVIEWED YES NO REVIEW DATIE <br />TOTAL P,32 <br />Pill <br />ENVIRONMt NIAL HEALTH DIVISION FILES <br />1J1g0rR0R0Ut4D TANK (U-Sn CLEANUP SITE (I.OP) 0 Ii0U3JNGA6ATfA1EM' X SOLID VIIASTE FACIUTY <br />jrtt OTHER CLEANQP SITF NON -LOP) Q FOW FACILITY O 5000 WASTE VEHICLE <br />JtiFiERGFtO11Nt? TAHK (MONITOKWC.,'RI:MOYALj 0 V06, K"NEL *cwpty <br />,$;8C KA.ZARDOUB; WASTE OrNtRATOR kf,GHZKP-N RANGK U PKC# TREA:TMENTPLANT <br />C] TIERED PERMITTED FACIUTY 0 l MLfHOTEL 0 PUMPER TRUCK(YARDoCHI;M TG`ILETS <br />❑ -TA,TTDA+NODY PMCINU D POOL15PA O LAN!❑ USF -APPLICATION SITES <br />Ar- MZ=At. WASTE FACILITY ❑ PUBLIC, WATER SY!$TEM 0 UTTER (f'L=ASE SPECIFY AGME;I <br />1. List up to ten addrasscs In the space rab4Ye. 9eloct iha typa(s) of f3lea from tits II -$t 4bove by Mecking <br />the, appraprlate box(es), At least une file typa MIJ$T be saWotad. Fax to (249} 464 0136 r mail o tf <br />address IndiCate!j ijW2ye- <br />2. EHD will notify thu applicant if any EHp fcl4s exist. An appointment for rcvjsw will be connrrned <br />appraxinTately five buslne" days but no later than ten (10) days after roc91pt of applic-alien. Tho files <br />Will be held for a maximum of five qusine$so days for review. AppointmentY ShOUld he schedulad <br />accordingly. <br />3. A file tial is actively heing wvrkod on by EHD staff may not be immediately awdlable for review. A new <br />a;ppli000A may be submitted when the Tito Is avaliRWe. <br />'t. Any file nut returned in the :tamQ ConCiitiOn as rel4: s8tr Will by reorganized by EHD Atbff at tht expense <br />of the applicant. Future filo review$ by the Same applicant may require a $97.00 deposit prior to rcvlew. <br />5. `TENTATIVE appoIntmiml dales must be COnfirrAed with EHD staff_ <br />6. Ap)(ica,flons received after 3.00 pm will be processed the next btiriness day. <br />CONFIRMED APPOINTMENT DATE TIME <br />[DATE CONFIRMED PHQNE FAX INITIALS <br />REVIEWED YES NO REVIEW DATIE <br />TOTAL P,32 <br />