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\ l <br /> SAS "ALUIN COUNTYFUHLiC HEALTH " WICrS <br /> .`.ENVIRONMENTAL HEALTH DLViS. r <br /> �rfL VLSI+Gv <br /> �J 1 304 EAST WESER AVENUE,THIRD FLOOR <br /> �I STOCKTON CA 95202Ll �� <br /> t (209)468-3420 �r <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLI n\ � i�Ll EIU3lNE5SlAGENCY <br /> A RESS � <br /> 1 S <br /> HONE Q iJO >AcslEurLi MAY 1 <br /> TENTATIVE*APPOINTMENT DATE TIME j • �� ;:' lv rlo' _�1Li i <br /> {Please glue 7 to 1D business days from dais otapplicatlon submkta[) �; a��,.F'r <br /> CiiECK CiOX TO EXPEDITE;REQU -$78_b4 FEE_REQ STP OGE SED IN 3 BUSINESS DAYS1QdL <br /> 1 <br /> SIGNATURE OF APPLICANT Aq A A 41DATE f p <br /> FILE ADDRESS <br /> tlumbt 4age vv <br /> 1N C ftii ati It <br /> ti _ <br /> � - - - - - -- 35,x'► �-ti.J <br /> ENVIRONMENTAL,HEALTH DMSION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE{LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILrTY <br /> OTHER CLEANUP SITZ=(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEIfIGLF, <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KE=NNEL ❑ DAIRY <br /> HAZAROGUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> d TIERED PanmrTTED FACILITY d MOTELIHOT'EL C1 PUMPER TRUCKfYARn/CHEM TOILETS <br /> ❑ TATTOOIBODY PEiRC1NG 0 POOUSPA Q LAND USEAPFUCA71ON SMES <br /> C7 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. LI.5t up to ten addresses in the space above. Select the typO(s)of files frons the list above by checking <br /> th+ appropriate box(es). At least one file type MUST be select4d. Fax to(209)46.4-0938 or mall to the <br /> addrMs'indicatgd 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(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 on by EHD staff may not b4 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 expanse <br /> of the applicant, Future'fiie reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 3. '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 /> EH VD 14 61to-wo <br />