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08--21--2eCo 02=£tFM TO 6673BG0 P.01 <br /> S �OARUIPt Ct�UN1TYPUE3LIC HEALTH SL'TYICES -=,y <br /> ,r <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUP,THIRD FLOOR <br /> AUG 2 �"",• �"... <br /> 5 2000 STOCKTON CA 95202 <br /> (20 )468-34,20 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PE Mi 11IM <br /> APPi} //---�� 5 t DV31NE55lAGE?iCY <br /> ADDRESS <br /> PHONE_eA09,�—p a M-% FACSIMILE O�- <br /> TFh!FAmrE'aFPaxTxENTnArF E>P,<~�, ,,2- oc2e) Timi 1 , 002- }4,,.1 Coa �t <br /> (P1eaSe gave 7 to 10 bunnecs days frnrn date of aPPH=0on t <br /> Gubntitw) U- <br /> L7f^ n <br /> CHECK BOX TO FXPEDI TE REQUEST•587.0(1 FEE-REQUEST PROCESSED IN 3 DUSthEss DAYS I <br /> SlCiIkATURE OF APPI 1GANT DACE n <br /> F E Ai?D S THIS SIDE EHQ STAFF US-E ONLY t�L� <br /> �' ��^ . 4 J31✓c� PR ORM ELEMMM SEARCH <br /> Cr <br /> a <br /> .tl .ter �T <br /> f: { <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> .�UNDERGROUND TANK(USI)CLFAMUPWE(Lop) d HOUSWGAUATEMEkT 0 SOLOWASTE.FAC&ITY <br /> OTHER0-RANUPSrrE(MON-LOP) O FOOD FACILrrY -0-SOLIIIWASTE YL•HiCLE <br /> .G'UNDERGROUND TANK(W0NTT0RU4CtREf40VAL) 0 DOG KENNEL 0 DAIRY <br /> 1iA7•aRDOUS WASTE GENE"TOR Q CHICKEN RANCH 0 PKO TRICATWNT PLANT <br /> TIRED PERMITTED FACILITY l7 MOTELMO7EL 0 PUMPER TRLCK/YARMCMEM T'OILE'TS <br /> a TAr-,001301)YP$iRCLNG ❑ POOU3PA 0 LANOtISEAPPIICAT"SITEs <br /> 0 MCOWALWASTEFACii.ITY -P'PUBLICWATER SYSTEm M OTHER fPLEA'SESPFC4PYADOM <br /> 1. List up to ten addresses in the space above. Select the type($)of files frorn the list above by checking <br /> the appropriate box(ea). At least Gne file type MUST be soleCted. Fax to(209)4844938 ar MA !o the <br /> �r8ss Indicated above <br /> :2. EHD Will notify the applicant if any EHD files exist, An appointment for rovieWWRI be Confirmed <br /> approximately five business days but no later than ten(10)stays after receipt of apPECatfon. The files <br /> will by held for a maximum of five Business pays for review. ,Appointments should be schedu(od <br /> accordingly. <br /> �. A fills that Its actively being work0d on by EHD staff may not be irrimediatoly available for review. A new <br /> aPptication may be submitted when the fiie is available. <br /> 4. Any file not retumed in the$aMe,rondltton a3 released will be reorganized by EHD staff at the expense <br /> of the applicant, Future file rgvlews by the same applicant may require a W7.00 deposit prior to revlew. <br /> 5. 'TENTATWE aPpalntment dates must be Confirmed with EHD staff. <br /> 6• Applications received after 3:40 pm will be processed the next bus"u>less day. <br /> CONFIRMED APMNTMENT DATE <br /> TIME <br /> III <br /> �.DATE CONFIRMED PRONE FAX INtTIAcL$ <br /> I <br /> EVIEWED YES NO REVIEW bA"PE <br /> OP{♦ ?FCT,'OP <br /> TOTPL P.01 <br /> TOTAL P.01 <br />