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"TE NL'GEIvE <br />APPLICANT <br />SAN tAQUIN COUNTYPUBLIC HEALTH(WRVICES <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 />ADDRESS //V T" L/.4W vac �'y�jt,.� c:w��-I„•,�v.,.. ._c�i <br />PHONE„ W'7Ci��,�� FAdSIMILE <br />--7937 <br />ENO `OG NYMaeR <br />TENTATIVE' APPOINTMENT DATE <br />(Please give leP b M d iron of apps Ion submllWl MENT UAI Tf <br />TT 5E PER(v1IT/SErivl ES <br />CHECK BOX TO EXPEDITE REQUEST 389 EE— OUE PROC SE B (NESS GAYS _ <br />SIGNATURE OF APPLICANT DATE 02 <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTALMhALiNurvwlvNr•IL= <br />TANK (UST) CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />LITY <br />0 SOLID WASTE FACI=THER <br />0 SOLID WASTE VEHICLE1 <br />UNDERGROUND <br />CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITY <br />NDERGROUND TANK (MONITORINGIREMOVAL) <br />11 DOG KENNEL <br />0 DAIRY <br />O HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY <br />0 MOTEL/HOYEL <br />O PUMPER TRUCKIYAROICHEM TOILETS <br />0 TATTOOIBODY PEIRCING <br />O POOLISPA <br />0, PUBLIC WATER SYSTEM <br />O LAND USE APPLICATION SITES <br />0 OTHER (PLEASE SPECIFY ABOVE) <br />0 MEDICAL WASTE FACILITY <br />1. List up to len 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 rile type MUST be selected. Fax to (209) 464-0138 or mail to the <br />address Indicated above. <br />2: EHD will notify the applicant if any EHD riles 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 bald for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that,ls actively bWng 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 ih the same condition as released will be reorganized by EHD staff at the expense <br />of the applicant Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3:00 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 />•.mgr <br />TO 39tld X31d3A LEBLGLSOG9 69:11 Z06Z/91/66 <br />„JL � <br />