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�iYl ; 1, U SAN . '�1G UJN CO�iNYYPUBLiC HEA�.I'H rs tVIGEb <br /> tIc� \, � _ <br /> J ` -cNViR4NfVlEN7AL HEALTH DiV15lk,t.a <br /> t] 3D4 EAST WEBER AVENUE,-THIRD FLOOR ., <br /> Zd�9 STOCKTON CA 952022_41Z <br /> N0� (20S)468-3420 :__. <br /> ENT V PUBLIC .RECORDS RELEASE APPLICATION <br /> �NB1��L]CA��N7' <br /> Cal) ��. - _ 6U31MES3lAG!"NGY adauCed <br /> ADDRESS -7 CA <br /> PHONE - 90 FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE_ _1.9.f_ 40 TIME <br /> (Phase give 7 to 10 business days from date of appfication submittal) <br /> GI-IECK SOX TO EXPEDITE REQUEST-STS EE—RgNQUEST PROCESSED IN 3 IRUSLNESS DAYS <br /> SIGNATURE CIF APPLICANT DATE <br /> !I <br /> FILL=ADDRESS <br /> co <br /> ,3S•�4 Tip I - _J <br /> ..tea <br /> ENVIRONMENTAL HEALTH DIVISION FILES . <br /> LiNDERGROUND TANK 4USTi CLEANUP SITE(LOP) ❑ HRUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-L OOP) O FOOD FACILMY 1:7 SOLID WASTE VI-HIC14E <br /> 13 UNUFRGROUND TANK(MONITORINGIREMOVAL1 ❑ DGG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ pKG TREATMENT PLANT <br /> C] TIERED PERMITTED FACILITY 0 M4TELIHOTEL Clp(JMPER TR11CK1YARD?CHEM TOILETS <br /> 4 TATTGOiBODY PEIRCING 0 POOLISPA is LAND USE APPLICATION SrrES.� <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABQVF-) <br /> 1. List up to ten addresses in-the spaco above. Selact the types) of files from the list above by checking <br /> the appropriate box(es). At least one file type MUSTbe selected. Fax to (2991464-0138 tar rnail to the <br /> Address indicated above. <br /> 2. FHD will notify the applicant if any EH D files exist. n appointment for raView Will be CQnfjrmetl <br /> approximately five business days but no later than ten (10)days after receipt of application- Tlie flies <br /> will be held for a maximum of five business days foto review. Appointments should be schedulki <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHO staff may not be immediately available for review: A new <br /> application may be submitted when the rite 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. FtltUre file reviews by the some applicant may require a $78.04 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confinned'IwIth EHD staff. <br /> 6. Applications received after 3:00 prn will be processed the next business day. <br /> CONFIRMED APPOiNTmENT DATE TIME <br /> BATE CONFIRMED PHONE FAX INITIALS -- <br /> REVIEWED YES NO REVIEW DATE <br /> E++oQ �a auavao <br />