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tnU L41i.UMtlFJi <br /> SAND JOAQUIN COUNTYPt}BLIC HEALTH SERYi%;ES <br /> \ ENVIRONMENTAL HEALTH DJVISION / I <br /> V 304 EAST WF CK AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (M)"B-3420 on <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> `I ; <br /> APPLICANT Agt;6Hfj tj 1(;,p� auswesslAGENCY <br /> ADDRESS4) <br /> a L3 <br /> PHONE ..��_.✓-.3� j� FACSIMILE <br /> TENTATIVE'APPOINTMENTDATE� TIME <br /> �'.,.,1 • <br /> {Pleas!fllva i 1v 10 bualnaLf e.y.Tram Qalo otappScpIME a�bmtttalj <br /> 'WCHECK BOX TO EXPEDITE REQUEST-578.00 FEE— <br /> REQUEST PROCESSED IM 18USINESS DAYS <br /> SIGNATURE OF APPLICANT `0&.t_ Le�nj DATE <br /> F[LEADDRESS TIM 3909 KIM STAFF 118E ONLY O <br /> PAOOALAM ELAMENTS SEA90i <br /> I of As i Gtif ATG {tt R - NO le 0 <br /> 113Oy sRS' Ctil4rz[ 2 _SU 3 � ; 51` i z;_ Z <br /> -» '( - 1 <br /> 1 5 B C T2 Gvin 2 <br /> figlY0 C7ch <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDCRGROUND TANK(VST)CLEANUP STIs(Lop) O HOUSING ABATEMENT 4 SOLID WASTE FACILITY L�(� <br /> 'X OTHER CLEANUP SITE(RON-.OP) q FDDU FACILITY ❑ SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITOftjKo,R MOVAL) El DOG FACT I p ppLIY MAR <br /> FIATARDOU$WASTE GENERATOR O cletcl(EN RANCH ❑ PRG TREATMENT PLANT MA l L y <br /> !7 Tlenry PERMnTEO FACNTTY ❑ MOTEUNO t. C1 PUMPER TRUCWY <br /> q TATTOO1RoaY FEIRCMxt ❑ PfSDiy9PA AI+OIGTTEM TOt1.ETS <br /> C] MEDICAL.WASTE FACILITY ❑ LAND USE APPLICATION SITES <br /> ❑ PUBLIC YJATGRSYSTEM Cl OTHER p+1EASE WEGIFY ABOVE) <br /> 1- List up to ton addresses In tho space above. Select the tyPe(s)of TilaS from the list above by checking <br /> th0 VPrcPdutc box(es), At least one file type MUST be selected. Fox to(fig)4611L or n to the <br /> 2. END will notlty Ms applicant N any END Olea extat An Appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)Ifaya Atter receipt of appticatiom The files <br /> will be held for a maximum of five buslnexm days for review, Appointments should be scheduled <br /> accordingly- <br /> 3. A file that It actively being worded on by END staff may not be immediately available for review. A new <br /> appliration may be submittad when the Ole Is available. <br /> a Any fife not returned In the same condition as released will be raer>aani:ed by END staff at the expense <br /> of the apPbcant. Future file reviews by the Aetna applicant may require a$19-00 deposit prior to review. <br /> 5. "TENTATIVE apPpihtmant dates must be Conf rrned with END mate <br /> B' APPlieatlons received after 3:00 Pm Will be Processed the next basin■ss day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> fDATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO <br /> r4 REVIEW DATE <br /> m u rmrAo <br /> T=L P.02 <br />