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02/ugrL 2L_b-:0.W47 5:37PMOI96ENVIRONMENTRL CLAIMS E3\NjRDR'"TAL FEALTH NO.303 RP.2/202 <br /> .,,.�.h,.,wn,• WIV Sac MUTAIIGA <br /> -SAN JO QUIN COUNTYPUBLIC HEALTH SERVICES <br /> v ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> I B 0 ti %003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPWCANTya^crl✓ {{&�J,� r /� <br /> $1-,}� OUSINESS/AGENCY 7 , /qn + pv✓�7 IJS( /gbce ( » n.? <br /> Y ADDRESS._ 7�' `�P�I ///A/',h Y/'il /� i� / -p % V�2,f - ✓ VO O •�.L7`'ro y <br /> PHONE�`�IJ� f'r7' �SA7 G FAGSiMILG. Cy/T� ✓ -,BGG _ _/ � <br /> TENTATIVE'APPOINTMPNTOATE rrCade C�u�� /Ilo Yr4[/y� TIME <br /> yyy- (Pieria plus 7 to ib bvslnass days from data W SppllWlkm submltWq Z rr� <br /> El CHECK BOX TO EXPEDITE REQUEST-$09.00 FEE-REQUEST PROCESSED IN]BUSINESS PAYS U n ! <br /> "SIGNATURE OF APPLICANT /a it -- OATE//{{4 �/ _✓� <br /> FILE ADDRESS TIe5 SIDE END STAI:F USE ONLY <br /> PROGRAM ELEMUFI'$SEARCH <br /> CvK6 M.4 <br /> ENVIRONMENTAL HEALTH DIVIMION FILES <br /> UNDERGROUND TANK 111571 CLEANUP SITE(LOP) O HIIU51MGATEMENT O SOLID WASTE FACILITY <br /> OTHER CLrANUP SITE(NON-LOP) L7 FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> O UNDERGROUNO TANK(MONITORINGIR6MOVAL) Cl DOG KENNEL O DAIRY <br /> �(HAZARDOUS wASTE GENERATOR O CHICKEN RANCH 0 PKC TREATp1Epr PLANT <br /> El TIERED PERMITTED FACILITY O MOTFLIHOTEL O PUMPER TRUCIUTARDICHEM TOILET5 <br /> r] TATTOWBODY FORCING O POOLISPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. Lfsl up to tan addresses in the space above, Select the types),of files from than lint above by chocking <br /> the appropriate box(es). At least one filo type MUST be selected. Fax tO (?,091 LY,:R138 ar-ILTa11 to the <br /> r address indicated above. <br /> 2. EHD will notify the applicant if any EMD,files exist. An appointment for review will be canfirmetl <br /> approximately five businoss days but no later than Ian (10) days after receipt 0 application. The files <br /> will he held for a maximum of five business days for review. Appointments shwufd be schedulad <br /> accordingly. <br /> 3- A fila thaLls actively being worked on by EHD staff may not be Immediately av*Rable for review. A new <br /> application may be submitted whan the filo is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by 1---HD staff at the exponse <br /> of the applicant, Futuro filo reviews by the same applicant may require a $89.00 deposit prior to review, <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff.. <br /> G. Applications received after 3,00 pm will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE "'^ <br />