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1 U <br /> ­­­. V <br /> SAi .;Cj '�1iv Ljul�iT'fPLtI�LI $-IEALTn aF IC l �I .- <br /> VIRONMENTAL HEALTH DIVISiOl 4 0 <br /> EAST WF-13ER AVENUE,THIRD FLOOR DEC 1 � <br /> STOCKTON CA 95202 <br /> (209)4s8-3420 <br /> VIRONfENT <br /> Q- F'iEFLTH <br /> ;k �L1C RECORDS RELEASE APPLICATI �TF � <br /> - <br /> APPLICANT HUSINESS]AGENCY <br /> ADDRESS L100 5— 0)q ' C CA !� ScsZjC/JQa <br /> PHONE <br /> FACSIMILE a (6 / <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (please give 7 to 10 business Jaya from data of applfcatlon submittal) <br /> 00 <br /> CHECK BOX TQ EXPEDITE fit=DUES f-$ .0 E—RE VEST pRQCE3SED IN 3 BUSINESS DAYS <br /> 1`+1 DATE -Z. <br /> SIGNATURE OF APPLICANT <br /> FILE ADDRESS <br /> 1 <br /> l � <br /> I I <br /> Low l l <br /> ��w+�o•�'ia�� .�tidc, c �'°�o :.�OViM�2Y s.i <br /> Z- E42 rtj- AL HEAL H DIVISION FILES <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> O <br /> lgl THER.GROUNTANK(USN)CLEANUP SITE(LOP} C FOOD FACILITY D SOLID WASTE VEHICLE <br /> )8f OTHER CLEANUu P SITE{NON-LOP) O DOG KENNEL ❑ DAIRY <br /> UhIDERGI20UND TANK(MON ITORINGIREMOVAL) ❑ CHICKEN RANCH D PKQ TREAIMEMT PLANT <br /> CI HA7ARD4uS WASTE GrNERATOR p MOTFLIHOTEL L7 PUMPER TRUCK YARDICHEM TOILETS <br /> Q TIERED PERMITTED FACIUYY 0 LAND USC AI'PLICA'nQN SITES <br /> ❑ TATTOOI$OI)Y PEiRCING 0 POOLI ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> M MEDICAL WASTE FACILITY PUBLICC WATER SYSTEM <br /> 1, t.ist up to tart addresses In the space above. SeieCt 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).464-0`1 MOr mail to the <br /> address indicated above. <br /> 2, EMD will notify the appiicant if any END files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days often receipt <br /> shooof ld be s application. Ted he files <br /> will be held for a maximum of five business days for review. App <br /> accordingly. <br /> 3, Afile Ulat is actively being worked an by EHD staff tray not be immediately available for review. new <br /> appllcailon may be submitted when tltti file is available. <br /> 4_ Any file not returned in the same oonditiOn as released will be reorganized a 78.ED dby EHep s f prior staff at the a en;50 <br /> of the applicant. Future file reviews by the samo applicant may require <br /> iOW- <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 <br /> PHONE FAX INITIALS <br /> REVIEWED YES NO � REVIEW DATE <br /> EN 40 14 dirtarov <br />