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FROM TC 4671118 P.02 <br /> 03- 1 fl`1 ..�. ._... .._..�...�., <br /> muK 1 �� 1 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> E11N!h0NMl _ivi iiL--ALTH STOCKTON CA 55202 <br /> PERM!TiSERV'ICES (209)468-342D <br /> PUBLIC RECORDS RELEASE APPLICATION /may y"y <br /> APPLICANT91NES GENCY <br /> ADDFLESS Seq to <br /> � �'� <br /> PHONE, �7 ADD& FACSIMILE 467 z MAP U <br /> l9 <br /> TENTATIVE"APPOINTMENT DATETIME QK"L- <br /> (Pleane glre T t010 b"Iess days from dale of Vocation submidal) <br /> CHECK Box TO EXPEDITE REQUEST-�$, -00 FEE.—/REQUEST PROCESSED IN 8 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��yU A ^ DATE <br /> O <br /> THIS SIDE EHD STAFF USE ONLY _ <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> w <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> O URDERGROUNR TANK(UGT)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FAr&M <br /> O OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY - 0 SOLD WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORiNGIREMOVAL) 0 OO(L KENNEL O DAIRY <br /> Q HAZARDOUS WASTE GENERATOR O CHICKEN RANCH a PHG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY d MOTELMOTEL 13 PUMPERTRUCKNARDICKEIATOILET3 <br /> CI TATTOOteopY PEIRCING CI POOLISPA .... M LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY 0 PUBLIC WATLR 6LY31EM CTHEK iPLEA$U SPECIFY A90YE) <br /> 1. List up to ten addresses in the space above. Select the type(*)of files from the list above by checking <br /> the appropriate box(es). At least ono file type MUST be selected. Fax to(209)A64-0138 or mail to the <br /> address indleatad above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointmentfor 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 held for a maximum of fiva business days for review. Appointments should be seliedaled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediataly available for review. Anew <br /> appLiCatlon may be submitted when the file is available. <br /> 4. Any file not returned in the same condltion as released will be reorganized by EHD staff at the expense <br /> of the applicant f=uture file reviews by the same applicant may require a S87.ott 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 bualness day. <br /> CONFIRMS? APPOINTMENT'DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL4 <br /> REVIEWED YES NO REVIEW DATE <br /> w m to aaetmo TOTAL P.02 <br /> IDlLG 39bd <br /> NCINCOIS 30V STLTL9060Z 5E 0T LBD7/6L1E9 <br />