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uwf64FiC�Jv[n .. _. f-_� � Vtcl}Lth:kUi6�+E7� <br /> SAIML, QUIN COUNTYPUBLIG HEALT3l vlcEs <br /> 304 EAST WEBER AVENUE, DIVISIONTH <br /> THIRDFL)QR <br /> STOCKTON CA 95902 <br /> (209)4S&3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT - <br /> ' ADDRESS � � v vv <br /> PHONE FACSIMILE0r: _ <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Plass(Rive 7 to$G 4Msj daYS !Of rttil( <br /> a�vPlicatlen su>aa1) <br /> 'R <br /> --KECK 13ox-To ExPeOITEEQtIEST•$78-0l/0 FEE-REQUEST PF 0=9 ED iN 3 BUSIMP&S DAYS <br /> SIGNATURE OF APPLICANT DATE _ -- <br /> FILL A#Doness C C7 <br /> - <br /> SA <br /> 42 <br /> ll <br /> 4 yYy <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES 2tr� S <br /> UNDERGROUND TANK(VS7)C1Ji:A1 UP SITE ILDP) O HOUSING ABATEIRfW SOLD WASTE FACILITY <br /> OTHER CLEANUP SUE(NON-LOP) Q FOOD FACu.JW 9$01_11)WASTE VEHME C,i 5 dx_ <br /> - <br /> UNDEMROUNDTANK K TO;rGRE4NAL) OHa DAIRY l S VJ ✓) <br /> HAZARDOUS WASTE GENFJ�TQR CICKLN Ff;" PKCMEATEMT PLANT <br /> M TWRE0)?rr.RM1TT&D FACRJTY M MQT"OTEL PUMPER TRUGKIYAItLlil:rlkM T011..VM <br /> C,,..] 7ATTr,Sgf$RPYPf=1RC1lG 0 POOLMIMA LAHDUSI-APYUCATIONSITES L,,, <br /> MEP1cAL VVA�rm FAauTY 0 PUBLIC:WATER SYSTEM OTHER JPLEA5E 5SPEn-F1'ABOVE) I� <br /> 1. Li.,t up to ton addro�et in the space above. Select the type(s)of files froIst a. cliecking <br /> the apQroprWe box[es]. At least ane file typo MUST be selected. F t 120914Fd-0938 or it to the 01 <br /> adder.§Indicated above. <br /> 2. EHO will notify the applicant if any EHL)tiles exist. An appointment for review will tm confirmed <br /> ApproMimately five business days but no later than ten(10)stays after receipt of application_ The files <br /> will be held for a maximum of five busi13es r.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 /> ai)Pftation 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 o 570-00 deposit prior to review, <br /> 5. "TENTATIVE appointment clates must be confirMed with EHD staff. <br /> S- Applications received after 3:00 pm will be processed the next business day. <br /> l CONFiRMFO APPOINTMENT DATE _ TIME - - -- -- <br /> I <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED ICES NO REVIEW DATE <br /> FM 09 14 QIM.Mg <br /> ToraL P.02 <br />