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SAN ")AQUtN COUNTYPUBUC HEALTH "7RViCES � <br /> � �y ,w�NVIRONMENTAL HEALTH DIVIS*,,4 <br /> J t 304 EAST WESER AVENUE,THIRD FLOOR <br /> �I STOCKTON CA 95202 �A <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLE K pU31NESSlAGI NGY r - ,_ �j f .�(l' <br /> A RESS y lett <br /> HONE,_Io2 :!Y6 1-166Z;1:8- 1 ACSiM1U a:;�11 III''I N1 AY ' 1 <br /> TENTATIVE"APPOINTMENT DATE ` -la v^ S .�rj' <br /> TIMI �1 IQ Am" <br /> {Please gJ,re 7 to n business days from dam ofappacatlon submittal) F,TF I; t F <br /> XCHEOK 13OX TO EXPEDITE;REQU -378.00 FEE—Rf QytSTp OCE Sej IN 3 8tI3JNE;53 DAYS • t!r7 <br /> SIGNATURE OF APPLICANT DATE � Q <br /> E7LE ADDRIII <br /> - <br /> CPd A rr <br /> ENVIRONMENTAL HEALTH DMSION Flt-ES <br /> UNDERGROUN()TANK(UST)CLEANUP SITE(LOP-) 0 HOUSING ABATEMENT n SOLID WASTE FACII_i7Y <br /> OTHER C-LF-"UP SITZ={NON-LOP) 0 FOOD FACILITY C1 SOLID WASTE VE"ICLF- <br /> UNDERGROUND TANK(MONITORINIGIREMOyAL) 0 DOG KENNEL p <br /> HAZARDOUS WASTE GENERATOR C1 CHICKEN RANCH <br /> TIL7 PKGRTREATMENT PLANT <br /> TIERED PEHIu71i7I=D FACILITY 0 MO�l{�L 0 PUMPER TR1JCKjYARDlCNEM TOILETS <br /> TATTOOMODY PEiRCING C] POOLISPA App <br /> LAND USE> 11CATiON SrT>S <br /> C7 MEDICAL WASTE FACILITY II PUBLIC WATIER SYSTEM Cl OTHER(PLEASE SPECIFY AnovE) <br /> Z- L151 up to ten addresses in the space above. Select the <br /> above by ch <br /> thO appropriate box(es). At least one file type MUST be sepe type(s) <br /> f Fax foes r f20 0n] the 464 list-0138 or maltt o tJleg <br /> address indicated above <br /> 2. EHD will notify the applicant if any EHO files exist. An a <br /> ppointment fpr review wilt be confirmed <br /> approximately five business days but no later than ten(1 0)days after receipt of application. The fries <br /> will be held for a Maximum Of five business days fol'review. Appointments should be schequted <br /> ar�Ording ly. <br /> 3. A file that is actively being worked on by EHD staff may not by 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 reorganizod by EHD staff at the expense <br /> of the applicant, ruture'file Faviews by the same applicant may require a $75.0{?deposit prior to review_ <br /> 5• 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3.00 pn•1 will bo processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX <br /> 11V171ALS <br /> REVIEWED YES NO <br /> A REVIEW DAT>" <br /> FH w a�roaua <br />