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NJ( ]UIN COUNTYPUBLIC HEALTH £ VICES .,. _.. <br /> 'rNVIRONMENTAL HEALTH DIVISIO <br /> IIS 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)4683420 / <br /> PUBLIC RECORDS RELEASE APPLICATION, I „ _.L ' <br /> APPLICAMT2-37 <br /> ?Ott J''�t(•7e /] GJI �l ,,JD�WJS-I�1NL'-S$lAO/E}N�CY GdLV.�{'yt ClpC�^ IIFCJ iGIIW, t/ <br /> ADDRESS aJ 1 SA&L(! R00d, *60tS F C.If 25;2/-5-- <br /> PHONE <br /> so2/J <br /> PHONE =7`fJ"/ V� FACSIMILE g;?409- <br /> TENTATIVE-APPOINTMENTDATE �1rJD/ TIME I•t9'D <br /> (Plo"a give 7 to 10 businfts days hem date of application submittal) : I <br /> CHECK BOX TO EXPEDITE REQUES 78.00 FEE-REQUEST ROC SSAIIN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS _ O <br /> It tt N O aw" 0 23 6 <br /> uc . <br /> /l4 d <br /> If o2 _ <br /> ligO rr. . . .. s 8 22 ! 2zo, <br /> u a. t • if _ <br /> iA er it <br /> e a3o! t 20 6/, o o boa G2 yzo J <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WA5TE FACILITY W . <br /> OTHER CLEANUP 51TE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WA$TL VEHICLE t4 + <br /> UNDERGROUND TANK(MONITORING/REMOVAL) '❑. BOG KENNEL ❑ DAIRY J <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> in TIEREp PERMITtED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRUCKlYAR21CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> G MEDICAL WASTE FACILtIY ❑ 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 (2091464-0138 or mal)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 rive business days but no later than ten(10)days after receipt of application. The tiles <br /> will be held 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 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 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 /> ENO 14 1V = <br /> d <br />