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igki 1U:4U r:11 baz1U ....,Taas 9r0;; <br /> nl�27 20th 10-16AM FROM �s �,� CH0LOG WJUOCu <br /> SAN _OAAI IIN f_At INTYDI IRI If_ 14PAI T-- Q---—-_- l' <br /> EMVIR0NMF-NTAL HEALTH DMIS5 <br /> 304 FAST WEBER AVENUE,THIRD FLOOR . <br /> O STOCKTON CA 95202 <br /> (209)466-3420 <br /> " - a- PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY <br /> _ 7.7-4A 4w tt7^kA. e 4 T„Q�s ,�t. /J/Pvnn 47n <br /> ef�hD�cc 7 • FACSILte <br /> PHONE o 30 <br /> �Sd3�bfid <br /> TENTATIVE-APPOINTMENT DATE �r( � TIME <br /> (Ple me glva T to 10 pusiness days trom data of applIcatfoh Submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$78. FEE-11/F�fiC1�PROCPSSED IN 3 BUSINPSS pAYS <br /> nDATE <br /> SIGNATURE OF APPLICANT <br /> tl(J„Q <br /> FILE ADDRESS <br /> ISO S. kfor1�W fc��fcn LUST !2G0 <br /> �}�P�o �n ✓ f1PS D S• .'f/� ��f ty� fp��l�^ V T <br /> rim ! s Ori 4 fngHon <br /> 0 p'� Ma n v,�a r F,'lPS <br /> /,X. Wow;lle? <br /> ------------------ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> D HOUSING ABATEMENT D SOLID WASTE FACILITY <br /> r1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) Q FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> Q OTHER CLEANUP SITE(NON-LOP) p DOG KENNEL ❑ DAIRY <br /> D UNDERGROUND TANK(MONiTORINWREMOVAL) O CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ MOTEUKOTEL ❑ rumpERTRUGYJ`lAftv'GHE6RTOILETs <br /> 1.1 TIERED PERMirrF-D FACILITY ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BODY PE(RCINGi7 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> C3 MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type(S)of cites from ag t 'the 4list64bovee by�i}ht ting <br /> the appropriate box(es), At least one file type MUST be selected. , <br /> address indicated above. <br /> 2- EKD will notify the applicant if any END files exist. An appointment far review will be confirmed <br /> approximately five business days but no later than tcn (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 a>rflvely being worked on by Elio staff may not be immediately available for review. A new <br /> application may be submitted when the file is aVUlIab(G- <br /> 4. Any rile not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future fila reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with END staff. <br /> b. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> I DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEV4�EQ YES NO REVIENIt DATE <br /> EM DO 14 OVO&VU TOTAL P.02 <br />