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01 L18;UU i ki lu:aU 1-AA UJz1U: TO <br /> — uo tx rwncu <br /> l " nl ^7-?�O ltd-16Gf1 FROM <br /> _ <br /> -,Am 1f')A(: IU!N f't'Y1INTYDIIRI Ir H;:Al TH CFRV�r <br /> ENVIRO!gMFnt_TAI HEALTH IIIVICir)IJ <br /> 304 FAST VVFRER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ��� d�IL BUSINESSIAGENCY <br /> -7 �/ <f. Tholo><.-t, /1/P�1nr1 'I , - �i - <br /> ennoccc � / min �G9/ WJ/5�/)1?�� '-� � -rte' r <br /> yv l� b-f 7o 30 FACSIMILE ���� ` d �� <br /> PHONE &52q,0 <br /> � TIME TED <br /> DATE <br /> TEN7ATNE APPOINTMENT - s from date oapp 'ltion l) FEB submitta <br /> (PtEwsq 91va 7 tg'ft]puSir+ess day f ll <br /> —'3 2000 <br /> CHECK BOX TO EXPEorTE REOUEST-$78. FFE—RE UFST PROCPSSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPI-ICAN 1 <br /> FILE ADDRESS <br /> �k 5 14 NO <br /> H / D �1,. oaf w t�oC L✓5 r <br /> I �PrO r•S/,^i PS, /lUn `7 S• �i�paif W� font{nn <br /> } <br /> r— <br /> ENVIRONMENTAL HEALTH DIVISION FILE5 <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTL FACILITY <br /> ri UNDERGROUND TANK(UST)CLEANUP 517E(LOP) Q FOOD FACILITY ❑ s0L1n WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) DOG KENNEL ❑ DAIRY <br /> 1:3UNDERGRQUN0 TANK(MONITOR(NGlRFMOVAL) O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HA.ZAtiDOUS WASTE GENERATOR 0 140TEUKOTE' C] PUMpEF.,.UCKrvARU C"Efe-TOILETS <br /> r1 TIERED DERMITTF_O FACIL" ❑ POOU5PA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PEIRCING C3PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> D MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of fifes from the list above by checking <br /> the appropriate box(es). At least one 1`110 type MUST be selected. Fax to r2rlai 464-x1138 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 beset on. The files <br /> approximately five business days but no later than ten (10) days after receipt of app <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> ac[.ordingiy- <br /> ? A fi!c that i:. actively being worked on by EHD staff may not be irtlmetiiateiy available for review. Anew <br /> application may be submitted when the file is availabtc. <br /> q, 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 $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 CGP+rlRlr+tts <br /> PHONE FAX INITIALS <br /> { REVIEWED YES NO REVIEW UATr --� <br /> FH oo 14 ota.00 TOTAL P.02 <br />