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✓f// Sh;� ,! UfN COUNTYPUSL1C HEALTH SICES <br /> ENVIRONMENTAL HEALTH DIVISIG <br /> 204 BAST 11VEBEP AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLI Ni QUS1AiESSPAGENCY /f 'l <br /> A RES&23" <br /> D9 ~IDQ W1Y S' '1'J1 MAY � i <br /> tiCJNE, rAf;51iti41LE __ - <br /> TIME <br /> TI-NTATiVE*AYPO1 FNT DATE <br /> (Please give 7 to i business days from dace of applicatlan sulorrtltcaf) ice. s, t <br /> + 1 ■ <br /> iR r, <br /> cr+>= x sox TICFxFeorrF rtEQu spa-aQ Fel ria sr P�E�Si tr IN <br /> SIGNATURE OF APPLICANT DATE <br /> ti� F tl ft o24 <br /> lad- rMI- 11- <br /> 2 39 2 3br, 2—?3&0 <br /> �r <br /> \; a /( X36/, 95 ,X235 �?30% ?3Q X36 360 303 a3 230 z3c ' <br /> � 1 <br /> AFI: <br /> w <br /> 1V �c at 1+ 1r <br /> ENVIRONMENTAL HF—ALTH DiV1510N FILES <br /> S{ UNDERGROUND TANK(UST)CLEANUP S1TL{1�a1'J C` HOUSING ASATEi1 eNT 0 SOLID WASTE FACILnY <br /> '`hid" Cl FOOD FACILITY 0 �ULjo WASTE VEi1JGLJG <br /> OTHFR CLEANUP SITh(NON-LOP) 0 OA1RY <br /> UNDERGROUND TANK(M0HtT0Ri24Q1ZE;ffAOVAL) 71 DOG KENNEL © FK6 TRI A7MGNF F'LRlrr ,I� 25 2301 <br /> NA.ZArttDOUS WASTE GENERATOR Q CHICKEN RANCH 8 <br /> n I�FREO PERMITTED FACILITY' 0 MOTELIHO7EL G LAND <br /> TAPPLIYA'nON "' 7 1 TS <br /> Il TATT00jAQDY PEIRC)NG 0 POOLISPA Cl LANf7 USf APPL1CA710N 3[[`C.5 <br /> C, MEDICAL WAU E FACILITY a PUBLIC WATER SYSTEM 0 OTHr=R(PR Fd~ E SPFCIVY AROVE} <br /> 1. Lht up to ten addresses in the space above. Select the types) of files from the list above by checking <br /> tht appropriate box(es). At least one file type MUST be selected. Fax to (22)464-0138 or m{t€!to-the <br /> address'indicatQd above. <br /> 2. EHD will notify the applivant if any END Iles exist An appointment fpY review will be ctanflrmed <br /> approximately five busirteos days but no later than ten (10) clays after receipt of application. The files <br /> will be hOd for a rnaxirnurn of five buslness days for review. Appointments should be scheduled <br /> accordingly, <br /> S. A file that is actively being worked on by EHD staff may not bo lMrnediately available for review. A new <br /> application may be submitted when the file is available. <br /> d. Any fii� not returned in the same condition as released will be recarganliod by EI-1I7 staff at the axpen-se <br /> of the app€i"rit, FLiture'filo reviews by the carne applicant may require a $78.00 daposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be Confirmed with Frit]staff. <br /> 6. Applications received after 3.00 pm will bo processed the next business clay. <br /> CONFIRMED APPOINTMENT DATE TIME .� <br /> DATE CONFIRMED PHONE FAX INITIALS � -- <br /> REVIEWED YES NO REVIEW DAA - <br /> EH 40 ]i 41NJloo <br />