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L DATE RECEIVED 2� SAN JCti ,ZER U1N COUNTYPUBLIC HEALTH Zr V)CES En LwN'ne J �fdVfRONMENTAL HEALTH DIVISION D 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 95202 / (209}468-3420 C) ��AA PUBLIC RECORDS RELEASE APPLICATION APPLICANT" IVlatri Et4Lo. trµttS QU37r'IESS/AG£NCY �oK� [s '(�,� Or LraN 2 �c I�vlo Lo l c5 inc. ADDRESS 1 g Pro..n k C -A 9 S2a PHONE 2.0'1 - 253 - OSI 6 FACSIMILE TENTATIVE' APPOINTMENT DATE TIME (Please give 7 to 10 business days frc daft of application subu iHaq CHECK BOX TO EXPEDITE REQUEST- $87.0,00 FEE- REQUEST PR C- IN 3 BUSINESS BAYS SIGNATURE' OF APPLICANT `�y � DATE 8 191 U-1 / ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) CI HOUSING ABATFMENT 11 SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY C1 SOUD WASTE VEHICLE C3�URDERGROIIND TAANt�K (MONITORINGIREMOVAL) ❑ DOG KENNEL tB"O�AIRY C HAZARDOUS WASTE, GENERATOR E!" CNICKEN RANCH ❑ PKG TREATMENT PLANT CI TIERED PERNOTT'ED FACILITY ❑ MOTELMOTEL O PUMPER TRUCKlYARDICHKAT TOILETS ❑ TTATTOOISODY PEIRCING - ❑ POOIJSPA, " I O LAND USE APPLICATION SITES 52'MEDICAL WASTE FACILITY ❑ PUIIUC WATER SYSTE61 0 OTHER (PL,£ASE SPECIFYABOVE) 1 • List up to ten addresses in the space above. Select the type(s) of files from the list above by checking The, appropriate box(es). At least one ffle type MUST be selected. Fax (Q(2g9) 464-0138 of mail to the address indicated above. 2. END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately five business days but no later than ten (70) days after receipt of application. The flies will be held for a maximum Of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by END staff may not be immediately available for review. A new application maybe submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review, 5. 'TENTATIVE appointment dates must be confnmed with END staff. 6. Applications received after 3:00 pm will be processed the next business day, CONFIRMED APPOINTMENT DATE. DATE CONFIRMEO TIME PHONE FAX INITIALS I / ENVIRONMENTAL HEALTH DIVISION FILES UNDERGROUND TANK (UST) CLEANUP SITE (LOP) CI HOUSING ABATFMENT 11 SOLID WASTE FACILITY OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY C1 SOUD WASTE VEHICLE C3�URDERGROIIND TAANt�K (MONITORINGIREMOVAL) ❑ DOG KENNEL tB"O�AIRY C HAZARDOUS WASTE, GENERATOR E!" CNICKEN RANCH ❑ PKG TREATMENT PLANT CI TIERED PERNOTT'ED FACILITY ❑ MOTELMOTEL O PUMPER TRUCKlYARDICHKAT TOILETS ❑ TTATTOOISODY PEIRCING - ❑ POOIJSPA, " I O LAND USE APPLICATION SITES 52'MEDICAL WASTE FACILITY ❑ PUIIUC WATER SYSTE61 0 OTHER (PL,£ASE SPECIFYABOVE) 1 • List up to ten addresses in the space above. Select the type(s) of files from the list above by checking The, appropriate box(es). At least one ffle type MUST be selected. Fax (Q(2g9) 464-0138 of mail to the address indicated above. 2. END will notify the applicant if any END files exist. An appointment for review will be confirmed approximately five business days but no later than ten (70) days after receipt of application. The flies will be held for a maximum Of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by END staff may not be immediately available for review. A new application maybe submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review, 5. 'TENTATIVE appointment dates must be confnmed with END staff. 6. Applications received after 3:00 pm will be processed the next business day, CONFIRMED APPOINTMENT DATE. DATE CONFIRMEO TIME PHONE FAX INITIALS