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❑A EREGEIY6D I )� IIIA Lu,.NuMFYd <br /> 5 N J( AQUIN COUNTYPUBLIC HEALTH SMVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> �I I 304 EAST WEBER AVENUE, THIRD FLOOR <br /> AUG 1. 6 Z001 / STOCKTON CA 95202 <br /> (209)465-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> . / <br /> APPLICANly r, <br /> DUSINESSIAGENCY�nceid <br /> ADDRESS x}93 �/ d �1 <br /> PHONE !909 (�rI ! ~IDV&_ FACSIMILE 7 - <br /> UG <br /> TENTATIVE'APPOINTMENT GATE CS � 71NE <br /> (Please give r to 10 buslnelks da date of applicalivn,mbmlttal) <br /> rs <br /> CHECK BOX TO EXPEDITE REQU $79.00 FEE—REQU P60C• ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> po OF, r7noO <br /> r� <br /> MS. err? T <br /> it <br /> 10N <br /> J 'J <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> VNDERGROUNU TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILMY ❑ SOLID WASTE vEHICLE <br /> UNDERGROUND TANK(MONTTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrrED FACILITY 17 MOTELIHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOGIBODY FORCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTTIER(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 12031464-013§ or mail to the <br /> address indicated above. <br /> 2. END will notify the applicant if any END 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 files <br /> will be hold 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 END staff may not be Immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any Fila not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$76.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day_ <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Ex oo is ele.fNo <br />