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SAN ON ON304 EAST ETvEN _ VICES <br /> ENVIRONMENTAL DIVISIR <br /> STOCKTON CA 95202 <br /> 9 <br /> PUBLIC RECORDSREL EASE APPLICATION <br /> A��tJCAfiT� &7f`7 BUSINESSiAGENCY �- <br /> ADORES5� <br /> PHONE AA Q / . <br /> `o?D U FAc31NfrE /// <br /> TENTATIVE'APPOINTMENT DATE TIME �� <br /> (Please give Ito 10 buslnass days from dale of applkaeon submidal) <br /> SU 24 '1n 1 <br /> f� CHECK BOX TO EXPEDITE RVQU ST-§79,00 P -REQUEr SSED IN 3 BUSLNE33 DAYS <br /> SIGNATURE OF APPLICANT pf DATE <br /> FILE ADDRESS <br /> it z S <br /> V Z a.... <br /> 1 <br /> p <br /> N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP$ITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONFTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOU$WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEM•TOILETS <br /> ❑ TATTOOfBODY PEIRCING Q POOLISPA 4 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY a PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I. List up to ton 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(209)464-0138 or mail to the <br /> address indicated above. <br /> 2 EHD will notify the applicant if any EHD 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 MOB <br /> will be held for a maximum of five business days for review. Appointments should be scheduled . <br /> accordingly. <br /> 3. A fils'that is actively being worked on by EHD staff may not be Immediately available for review. A new <br /> application 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 applicant. 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 /> 6. Applications racstvad 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 /> nasal <br />