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1___--,04/18/2005 10:15 FAX 209 946062 <br />aAz_I G�6 <br />� rED <br />0 <br />SAN -TaAQu1N CauNTY <br />ENMOn, EN rA-L REA,L'. H DEPARTMENT <br />r; <br />"05 30Q $' Teber Ave 3Flaar Stockton, CA 95205 <br />t(09) 4683420 Fax: (209) 464-0138 Web: wNYw.co.san-j0aqwa,=us/ehd <br />ENV1F'0NVENT H E A LT H <br />PE,r"" 'i121 VICES pljBLIC RECORDS RELEASE APPLICATION <br />APPUCIVCT. ok-1- T��i✓a BUSINESSIAGE,NCY: <br />ADDRESS: <br />PHONE: r <br />tj <br />TI-NTATIVE4' ApF0INTMENT DATL. —1ISL� <br />(picase allaw 10 business days from date of appiicatian submitral) <br />Q CHr-CK BOX TO FXPEDIM }QUEST -193,00 FEE— REQUEST PRo CF-SSED IN 3 BUSINESS DAYS <br />SI(3NATU RE Or APPI-ICANT <br />-ENVIRONM> NTAL HEALTH L)EPARTMI NT FINS <br />W40ERGROUND TANK (UST) CLEANUP Srrs; (LOP) <br />oTHER CLEANUP 5" (NON -LOP) <br />cEi. UNOERGRAuNU TANK (MONtToRINGIREMOVAL) <br />Ne HAZARDOUS wASTF GENERATOR <br />❑ TiERLD PERMrr7>`0 FACIL TY <br />d TATTMIEOOY PIERCING <br />❑ MEDICAL WASTE FACILfTY <br />List up to ten addresses in the space above. Select the type(s) of files from the list above ey checking <br />the appropriate box(es)- At least one file type MUST be selected. Fax to 209 4G"138 or mail to the <br />address indicated above. <br />EtjD will notify the applicant if any EH4 files exiSL An appointment for review will be confirmed <br />approximately five business days but no later than ten (i D) 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 />A file that is actively being worked on by FHD staff may not be immediately available for review. A ne% <br />application may be submitted when the file is available. <br />Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br />of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to revie' <br />"TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:40 pm wilt be processed the next business day. <br />1. <br />2, <br />■ <br />■ <br />■ <br />■ <br />■ <br />16002/002 <br />lz39 <br />HOUSING ABATEMENT <br />iRL sono wA5TE FACluw- <br />I`000 FACILITY <br />❑ SOUn WAM VEHICLI" <br />DOG KFHNEL <br />X1DAIRY <br />ELPKG TRF_ATMENT PLANT <br />CHICKEN RANCH <br />0 PUNIPERTRUCKIYARDiCHEM -r0'L:ET(Q—" <br />mOTELMOTEL <br />5k LANA USE APPLICATION SriES <br />POOUBPA <br />OTHFR (PLEASE SPECIFY) <br />-,C4N`�_[RM.ED.'A PPO NTNIF -N-r--DAT-13 <br />DATE CdNPIRMEICi <br />REVIEWED YES No <br />PHONE FAX 'JALS <br />.� <br />REVIEW DATE. <br />