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SANUIN COUNTYPUBLIC HEAL i ii cr=Z5 <br /> ko (IRONMENTAL HEALTH DIVISIO <br /> FEB 2 ZO�1 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 <br /> EPV10,Ui%: d"Ud I icALTH PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT QIFAQ I ri Lee- BUSINESSlAGENCY LllkaACPr7 6e0&—nUJPW,-) YK, <br /> re - e, , <br /> f1 -/D RILE a '7 <br /> : <br /> TENTATIVE DATE ' I ' n Z TIME 1• <br /> (Please give-f to 10 business days from data of application submittal) - <br /> K-`+. CHECK BOX TO EXPEDITE REQUEST-W. EE RE 5T PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A`� DATE 0 ( 0 <br /> FILE ADDRESS <br /> ✓ Z VL vt' O <br /> �Ltf 7L 3 L [ <br /> ✓ 7-- _ � i O r 1` <br /> ln^' <br /> u�F 3 =10 o J4 <br /> 1 <br /> " <br /> ENVIRONMENTAL HEALTH DIVISION FILES h ) <br /> UNDERGROUND TANK(USTI CLEANUP <br /> TE(LOP) 0 HOUSING <br /> 0 511L 11 IYA <br /> UNDERGROUND TANK(MONTORINGMEIMOVAL) ❑ DOG KENCNELL MENT 0 DAIRY ILITYWASTE VEI"Ct�I,V TI UES <br /> • HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PPLLANNTT(LL���UUU;INTI <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKlYARD/CHEtd TOILETS <br /> ❑ TATTOWBODY PEIRCING ❑ POOLISPA 0 LAND USE APPLICATION SEE% i <br /> 13MCDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABO } <br /> 1. List up to ten addresses in the 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 business days but no laterthan 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 an 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 END 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 /> N as a otmava <br />