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A EHG LOG NUMBER <br /> SAN JO NVIRO304 wE9NTAL HEALTHDIDIVISI FLOpVICES <br /> N � j <br /> (� STOCKTON CA 95202 C/� <br /> (209)4883420 <br /> P1 'GBLtC RECORDS RELEASE APPLICATION <br /> APPLICANT Mori ICT- I t{ �S BUSINESSIAGENCY (-Q%&A0V- 1=.0 ,6 <br /> � J � QC <br /> A0PRE55 15 ^ o- k JNG, 9SZ � <br /> PHONE 2-01 - 2-5-4 - CS 16 FACSIMILE <br /> TENTATIVE'APPOINTMENTDJATE 11 /�p /gocs I TIME <br /> (Plea 19 N`75 // 0/ <br /> ays ko1 <br /> ITapplication s�bmittalJ <br /> CHECK DOX TO EXPEDITE REQUEST-;87.00 FEE-REQUEST P :' O 1 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE tT/I'j Zao 7 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELFJ&NTs SEARcH O <br /> 'q20 *S, r.V1.ri�ar+ c1�vl� <br /> 2 S. C.wEi�riniA t <br /> 32 Ar.�wricar. <br /> 300 S. P. v +-icw.r <br /> ✓ 70 E . <br /> i 3aD S. [w t:. ra:A <br /> (64(a 5 . C_....►: n V - <br /> ✓308 IE . <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> r; <br /> SINDERGROUND TANK(UST)CLEANUP SITE(LOP) ff HOUSING ABATEMFNy M SOLID WASTE FACILnY <br /> b1HER CLEANUP SITE(NON-LOP) MFOOo FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL - 0 DAILY <br /> HAYAR130Ro WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMI7TF.D FACILITY ❑ MOTELIHOTEL. 0 PUMPER TRUCKIYAPUCHEM TOILETS <br /> 0 }ATT001800T PEIRCING ❑ POOLlSPA - ❑ LAND USE APPLICATION SITES <br /> Wr MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ 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. Fax to (209)464-0138 S mail to in <br /> address indicated apove. <br /> 2. EHD will notify the applicant if any EHD files 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 flles <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 rile 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$87.00 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 /> t:ONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />