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D SAN .i UlN COUN iYPUBLIG HEALTH S*ICES <br /> ENVIRONMENTAL HEALTH DIVISION 'ino/ <br /> S <br /> LL <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> MEN1 (209) 468-3420 <br /> gkTH rPUBLIC RECORDS RELEASE APPLICATION <br /> PERMI I/ <br /> \� e7 PPLICANT ] SUSINESSIAGENCY adIJ{vi n <br /> ADDRE55 Q !V UJ Q �' �1! 95:20,S- <br /> 0' 4'er <br /> PHONE <br /> !7 n f �- r <br /> qvo& FACSIMILE � � 1 �I � ti ` <br /> 1 F. <br /> r <br /> �t''� <br /> APPOINTMENT DATE TIME <br /> Y. <br /> s" Pleasa give 7 to 10 business a from date of application submittal) <br /> 840 <br /> v7 -06 ► Wiz_. <br /> FEE EQUEST PROCESSED.IN S BUSINESS DAYS <br /> SIGNATURA F`l PkICANT DATE <br /> FILE ADDRESS _ }: 1X A701 <br /> f- <br /> U < - <br /> ENVI ONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST}CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ soUD WASTE FACILITY <br /> i <br /> OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNt)ERGROUND TANK(MON ITO RINGIREMOVAL) ❑ OOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C7 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ID PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING 0 POOIISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 11 PUBLIC WATER SYSTEM 0 OTHEt2(PLEASE SPECIFY ABOVE) <br /> I. 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 209 464-0138 or mail tot e <br /> address in�llcated 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 files <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:OD pm will by processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 6N 00 1, 01105/DD <br />