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,l."�A1V�""1Wi1U11Y000NIYYULiLII;M AL1H Vic ES <br />�' //p'fV �yENVIRONMENTpL HEpI,TH DiVIS�'„�] I <br />304 EAST 4VEl3ER AVENUE, THIRD FLOUR w <br />STOCKTON t2A 95202 � �� \\ <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANTi��iaw " <br />1"1rr VN Ll f J BUSINEBSrAGENCY <br />PHONE };'Of- Z6 i/.- 2S <br />TENTATIVE�APPoNTMENTDATE_X2- 0O TIME <br />(Please 9We 71010 beSine s days [ram date of appllcarlan <br />CHECK BOX TQ EXPEDITE REQUEST - 373.00 FEE - REQUEST PROCESSED IN 3 BUSINESS PAYS <br />SIGNATURE OFAPPLICANT <br />OATS <br />FILE ADDRESS <br />THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DIVISION FILES/ <br />L4 <br />:caz.o �z <br />?J/ <br />13 SOLID WASTE FACILITY <br />SITE (NON -LOP) <br />22 -22 22 O ZlC <br />S � • t lYf /rt <br />K00 Ad. <br />� <br />�Z'1 <br />O DAIRY <br />Cl HAZARDOUS WASTE GENERATOR <br />CI CHICKEtti RANCH <br />13 PKG TREATMENT PLANT <br />O <br />[7 MDTFUNOTEL <br />n m <br />co D <br />❑ TATTONBODY PEIRCING <br />�a Z <br />T <br />0 AIEDICAL WASTE FACILITY <br />P <br />FILE ADDRESS <br />THIS SIDE EHD STAFF USE ONLY <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DIVISION FILES/ <br />L4 <br />:caz.o �z <br />?J/ <br />13 SOLID WASTE FACILITY <br />SITE (NON -LOP) <br />22 -22 22 O ZlC <br />S � • t lYf /rt <br />K00 Ad. <br />� <br />�Z'1 <br />O DAIRY <br />Cl HAZARDOUS WASTE GENERATOR <br />CI CHICKEtti RANCH <br />13 PKG TREATMENT PLANT <br />C3 TIERED PERMITTED FACILITY <br />[7 MDTFUNOTEL <br />❑ PUMPER TRUCKTYARDICHEM TOILETS <br />❑ TATTONBODY PEIRCING <br />CI POOUSPA <br />L3 LAND USE APPLICATION SITES <br />0 AIEDICAL WASTE FACILITY <br />O PUBLIC WATER SYSTEM <br />CI 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. EaK10. M 464-0138 or mail to the <br />Address indioaf d +hove <br />2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br />approximately fire 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 />3. 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 file is available. <br />4. Any file not returned in 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 $70.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 9.00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DA'L'E CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />rw m ie wiva <br />ENVIRONMENTAL HEALTH DIVISION FILES/ <br />3C UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHGLEANVP <br />ER <br />4 HOUSING ABATEMENT <br />?J/ <br />13 SOLID WASTE FACILITY <br />SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE l <br />❑ UNDERGROUND TANK (MONITORINGIRFmoVAL) <br />❑ DPG KENNEL <br />O DAIRY <br />Cl HAZARDOUS WASTE GENERATOR <br />CI CHICKEtti RANCH <br />13 PKG TREATMENT PLANT <br />C3 TIERED PERMITTED FACILITY <br />[7 MDTFUNOTEL <br />❑ PUMPER TRUCKTYARDICHEM TOILETS <br />❑ TATTONBODY PEIRCING <br />CI POOUSPA <br />L3 LAND USE APPLICATION SITES <br />0 AIEDICAL WASTE FACILITY <br />O PUBLIC WATER SYSTEM <br />CI 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. EaK10. M 464-0138 or mail to the <br />Address indioaf d +hove <br />2. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br />approximately fire 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 />3. 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 file is available. <br />4. Any file not returned in 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 $70.00 deposit prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 9.00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DA'L'E CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />rw m ie wiva <br />