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' SAIJN \QUIN COUN TYPUBLiC HEAL1I- .' tVI(:LS <br /> ENVIRONMENTAL HEALTH DIVIZIGat _ <br /> 1�C 304 EAST WEBER AVENUE, THIRD FLOOR <br /> NSU 1 q 2000 STOCKTON CA 95202 _ <br /> (209) 468-3420 <br /> [R���^^( ENS y�EA�SH <br /> PUBLIC RECORDS RELEASE( APPLICATION `�- <br /> EN BiPP&AI T / -X�•� 1 " �l.Y} �J HUSINESSIAGENCY O(fC(j7nCe ( 1't°f` & U1ky'0)1ye & LZr'[, <br /> ADDRESS `7 � .5� (.CJJ ( SD Q C lry -sa �s~ <br /> in <br /> PHONE as , -100 / FACCSIMILE <br /> TENTATIVE' APPOINTMENT DATE Z - - TIME t ` d D / ,1+11 <br /> (Plxase give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST - $78�p )EE - R EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT \ (1 DATE \\ 20 DD <br /> FILE ADDRESS <br /> c? zt 3S c2 cD <br /> tL4AO 3S3 <br /> .�SbYrn4L7 Lc7 X950 UJ <br /> , <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Til UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING AnATEMENT D $OUD WASTE FACILITY <br /> r OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUND TANK (MONITORINGIRFMOVALI ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR In CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING 0 POOLISPA O LAND USE APPLICATION SrTTS <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ten addresses inthe 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 businoss 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 fife that I5 actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the fete is available. <br /> 4. Any file not returned in the same condition as released will he 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 /> F� W a 011wo m- <br />