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,.�M.. .:rL. �✓: TO 8SB2E390 P.a1 <br /> SAN .1bAQUO VICES <br /> iN C <br /> UNTYPUBLIC HEALTH SE " `U; M""`U` <br /> E�VIRONIV EN rAL HEAt_TH DIVISION — <br /> 3q4 EAST WEBER AVENUE,THIRD FLOOR � 7-2— <br /> STOCKTON CA 9$202 <br /> 468-3420 <br /> PUBLIC: <br /> UBLIC;RECORDS f209RELEASE APPLICATION <br /> �APf�LCCAtiIY' �t'c�"C •4Jo �'SL!JQ.� SUSENESS/AGEMGY <br /> P-tt7NJ: <br /> (a 00- CA. cb'3A40 P) <br /> FAMMILE <br /> +ENTAT)VE*ApporNTA4ENT04TEkT. ,-1`' <br /> {Pleoaq piste 7tw tD buainoS6 cK,7�fr'g�data oC f 71ME <br /> �F.J{ �p Ecatior�submittal} <br /> � <br /> CHECK EOXPEUtT� <br /> _ REQUI ST-S$7.UO�Fi:6 R8 U�,pROCi^SSED INBU91NES3 DAYS <br /> S)©NATUIRE OF APPLICANT <br /> DATrz <br /> F11.E3 EIOri —� <br /> RESS <br /> YHIs MlZi,b EHul STAFF U$E.ONLY <br /> PROGRAM ELI:MENT8 SCARCe{ <br /> 'CdCY�Cdj - <br /> PAO <br /> At�w� --•t- t �E c. tom. "'Cly `�+4? oZ . <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROURG TANK(U$T)CLEANUP Sgrz(LOP) CJ HOUgINO AeATEPAlluT <br /> QTHXR CL�AJ`dUP 51TE jNQNB LCA) ❑ FOOD FACILt1Y 0 SOLID WASTE:FACILITY <br /> L)NDERGROUND 7AHX[jAjpWORJNGfPi>:&E}?YAL) C 3 FOC3 FACJ I. Q SOU&WASTE VIEIJ104E <br /> q I7lAZM6QUS WASTE GEENERAT4Bt CJ COG Kr N I�ACn1C}{ Q GAJRY <br /> Cl TJJ?ReO�PERmrrTFD PAcxjrY PKG TREATMC[NT PLAXT <br /> ID 7 ATTOW310pY PI RCING G t4OTEUHOT$L D PUMPER TRUGK YAT T <br /> 01. <br /> 11=rStiEWCAL WASTIS FACIUTy 0 P6013PA ' • AND� LTION O PUALIC WATER SYSTEM OTHER(FLEAWE SPECIFY AROVE) <br /> �. List up to tern.addre4ses In the space above. Select tho type($)of 1710&from the list above by Chet~ang <br /> nat <br /> the aApropte box(es). At least one file type MUST be$elected. F t 2 9 4B4 i3 ar <br /> a dr sin ate�t ove. �i..2_i ,— mail the <br /> �• - €HD will notify the applicant if arty ZHD files exist. An al]POirntman#for review will be aonfirme <br /> approximately five businsss days but no lat4r than ten(10)days after receipt of apjailcatEon. 7IEe fires <br /> .will be held for a maximum of five business days for review. Appointments should be Scheduled <br /> The <br /> accordingly. <br /> • -A file that T$fictively bents Worked on by ENE)Staff may not be imrn+ediatiely available for rOvlew. A now <br /> APPUatigh may be svbMittstl when the Rte is available. <br /> d• Any file not ro*tum9d in the same condition as released will he reorgaTiizeel by EMP staff at the expenza <br /> of thrt aTplicsant. Future flie revlews by the saMs applicant may require a $47.00 de <br /> S. ApplicationzIVE rateappiv trnent dears must be confirmOd with EHD staff. <br /> Ap JliCa#tor:$received after 3:00 pot will be processed the next business day.. P4Sit prior t6 review. <br /> i • <br /> CONRRMED APP0pjTMENTI]ATE <br /> TIME <br /> DATE? Cat4r-IRMED <br /> i PHONE PAX <br /> YES !d0 )NITIALS -------- . <br /> RE�IIEVY�A <br /> REVIEW DATE " <br /> TOTAL P.01 <br />