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, . . _ . <br /> fAQUIIV LA) LIN IT PUL LIU M17AL IH >"" RVIGLES <br /> ENVIRONMENTAL HEALTH DIVIE 1 <br /> (� 304 EAST WEBER AVENUE, THIRD FLOUR r <br /> X � STOCKTON CA 95202 ob <br /> ( <br /> IMI/p"/ {' UBLIC RECORDSS RELEASE APPLICATION <br /> �Y % .,. <br /> APPLICANT I / ww ylq lrw irJJ BUSINESS/AGENCY Grrt7sf4rrr1�,t <br /> ADnlxEss 2 /<I `/Ma/ N 5"7 rr ZTJ� trrsMe G/} �1 Zzsz <br /> PHONEFACSWILESS'9 ` � ry `/ ' T� `7 � / — <br /> -tom- 4.:.7.;.r <br /> TENTATIVE' APPOrfineENTIDATL 4/2 ';V-1BD TIME � m � <br /> (Please give 7 to 10 busiae days from date of appllcatlm Submittal) G F- <br /> C7 O(ZD <br /> CHECK BOX TO EXPEDITE REQUEST - 37ZmOO FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS fT, rl <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> :z 5 • S fw oW wt P �0;k L2Z,i) J Z "� <br /> 6/ .rColt'/ * 7d' w 122-7 <br /> S. � r L Lt f G hr 2 l �Z7 <br /> `yid MeH w tv 2'31 Z. <br /> ENVIRONMENTAL HEALTH DIVISION FILES l 2 <br /> 4Y UNDERGROUND TANK (UST} CLEANUP ME (LOP) q HOUSING ABATE6fENr ❑ SPUD WASTE FACIU"IY y(�/��� <br /> OTHER CLEANUP SITE (NONLOP) ❑ FOOD FACILITY ❑ SOLD WASTE VEHICLE J <br /> ❑ UNDERGROUND TANK (btONITORING/REMOVAL) ❑ DOG KENNEL El DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHIClC_NN RANCH ❑ PKG TREATMENT PLANT <br /> P TIERED PERmTTTED PACIUTY ❑ MOTELiHOTEL ❑ PUMPER TRUCKNYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FAC:UM ❑ PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ten addresses in the space above. Select the types) of files from the I'lsi above by checking <br /> the appropriate box(es). At least one file type MUST be selected. EaXto (2091 464-0138 or mail to the <br /> address indicafed 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 later than ten (IG) 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 reviews by the same applicant may require a $70,00 deposit prior to review. <br /> 5• "TENTATIVE appointment dates must be confirmed with EMD staff, <br /> 6. Applications received after 3.0D pm will bq processed the next business day. <br /> Mill <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DA'YE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Fll fA 10 aar�ao <br />