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J;1 """ <br />'P,EGEVEU ����AN� L�E5 <br />IWECENVIRONMENTAL HEALTH DIVISIONnyNp(H <br />3D4 EAST WEBER AVENUE, THIRD FLOOR " <br />AUG 9 2000 sTOCKTON CA 95202 <br />(204) 465-3420 <br />cnnnRnNIIFN A%1THPURLIC RECORDS RELEASE APPLICATION <br />17 <br />BUSINESWAOENCY <br />M9 <br />11l <br />PHQNE,J i<a� -1 �l'U J (�1~ FACSIMILE <br />TENTATWE" APPOINTMENT DATE mOf1 i 1 TIME L c?�"�`� <br />[Er' <br />(Please elva 7 to to bu in from date of applioadon sujrtb <br />E-� CHECK BOX TO EXPEDrrE REQUEST.-T.0o FEE -REQUEST PROCESSED IN a BUSINESS PAYS <br />DATE <br />SIGNATURE OF APPLICANT <br />111 <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) o HOUSING A®ATEMENY O SOLID WASTE FACILITY <br />O FOOD FACILrrr 6 SOLID WASTE VEHICLE <br />OTHER CLEANUP SITE (NONIOP) OG KENNEL fl DAIRY <br />❑ D <br />UNDERGROUND TANK NONITOKINCIREMOVAL) ❑ CHlCt(EN RANCH 0 PKC' TREATMENT PLANT <br />❑ HAZARDOUS WASTE GENERATOR O MOTEUNOTEL ❑ PUMPER TRUCWYARDICHrMTOILETS <br />11 TIERED PERMfTTED FACILITY PA <br />o MEOILNA WASTE FACILITY a PUBLIC OOUSOOUS L3 LAND VSE APPLICATION SITES <br />l7 TATTOOIBODY PEIRCING l7 PWATER SYSTEM fl OTHER (PLEASE SPECIFY ABOVE) <br />�. L,ist up to tan addresses in tho space above, Select the types) of files from the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 1209) 464-0938 or mail to the <br />address )ndleated abo 0 <br />2. EHD will notify the applicant if any EHD tiles exist. An appointment for ceiow will be confirmed <br />Approximately five 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- Anew <br />appl(oatlon 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 appllcant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />fi. Applications received after 3:00 pm will be processed the next baSineSS day. <br />CONFIRMED APPOINTMENT DATE TIME <br />[)ATE CONFIRMED PHONE FAX INITIALS <br />TOTAL P.02 <br />