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lc -l7ra al•adrrl rttijn I U 141!53E12lR5C, P.02 <br /> Dq'fE kEr_s.c6 END LOG truueEfz <br /> SAN J( 1UIN COUNTYPUBLIC HEALTH SE 10ES _ <br /> ­MP,ONMENTAL HEALTH DIVISION 7 9 —3� y <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> {209)468-3420 <br /> PUBLIC RE-CORDS RELEASE APPLICATION <br /> APPLICANT_ --- aUs►NESSIAGENCY <br /> ADO RES$ <br /> PHONE-- Cifi`aa z- � 1Tq FACSIMILE �I f�(1Sr <br /> TENTAME*APPOMTMFMT BATE_ /Z-30- / TtrAF: <br /> (Please glvc'7 to 10 business days from date of appbc-.ation subnlittdl) <br /> CHECK 13OX TO EXPEDITE?REQUEST•$T8.00Z REQUEST PROCESSED N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> L77 <br /> e "n- Z c,-',' <br /> c, F <br /> (Z ov n/V <br /> P� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> XUNO£RGROUND TANK(UST]CLEANUP SITE(LOP) ❑ HO:ISING ARACr-MFNT d SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(HON--OP) ❑ FOOD FACELrfY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MOHITORWGJRE140VAL) Q DOG KENT-L M DAIRY <br /> HAZARDowii WASTE GENERATOR Z7 GHICKLN RANCH D PKG TREATMENT PLANT <br /> CI 'nERED PFRMrrWD FACILfTY ❑ MOTELIHOTEL 0 PUMPER TRUCWYARDICHEM TOILETS <br /> C3 TATTOOSODY PEIRI:ING ❑ PQOLSPA ❑ LAN13 USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY AGOVF:} <br /> 7. List up to ten addresses in the space above. Select fhe type($) of frIc—­from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 09)_464-0138 or mail to the <br /> ad�re�s ndicated 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 revtew. 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 returried In the sarrme N,af]dition aF 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 /> S. 'TENTATIVE appointment dates must he confirmed with EHD staff. <br /> G. Applications received rafter 3:Qo pm will be processed the next business day. <br /> f\C.Y ICV1 r._ •L;RL.', <br /> ..., r. .. :tie .IZEVI .D.T, `..' <br /> USaHY <br /> TOTAL P.OZ <br />