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DALE RECEIVED fHn LOG NUNBEN <br /> SAN J4VIRONIVIENTAL <br /> UiN COUNTYPUBLIC HEALTH Si 'ICES <br /> HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 85202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION Aj <br /> APPLICANT_� /t//(//�"�iQ v4. --9d I Nf--two 04 <br /> ADDRESS _�� zz-t -T <br /> G � <br /> PHONE_ �d ^ /_�j y FACSIMILE 62— <br /> I <br /> TENTATIVE'APPOINTMENT DATE TIME O <br /> (Please givo 7 to 10 business days from date of applicatlon suumottal) O <br /> CHECK BOX TO EXPEDITE REQU ST-$78.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SI TURF OF APPLICA DATE O <br /> N <br /> FILE ADDRESS (1 <br /> - — e nd <br /> FER <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY C3 SOLID WASTE VEHICLE <br /> }UNDERGROUND TANK(MONITORiNGIREMOVAL) O DOG KENNEL O DAIRY <br /> Q HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> �j TIERED PERMITTED FACILITY ❑ MOTELJHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILETS <br /> C) TATTOOIBODT PEIRCING ❑ POOL/SPA O LAND USE APPLICATION SITES <br /> G MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1, List up to ten addresses in the space above. Select the type(s)of files f th�464-0or <br /> by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax o 209 mall to th <br /> addro"Vindicated above. <br /> 2. EHD will notify the applicant if any END 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 roviews by the same applicant may require a $78.00 deposit prior to review. t <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 /> GH 00 N 01MY00 <br /> TOTAL P.02 <br />