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PA�n� 611 U4 <br /> tnu Lw 1wVZ'K <br /> 6a X72 <br /> r S NN 013NIN <br /> EN-VIRON-iNIENTAL REALTH DEPARTME1,11, <br /> 1,1 r IN <br /> 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br /> TeleplAonc. (209)468-3420 Fax: (209)464438 Web: www,sjaQv.otg/chd <br /> ul_j <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> ADDRESS. <br /> P14ONE(I), PHONE(2): <br /> 'FACSIMILE. <br /> TENTATIVE*APPOINTMENT DATE: Time. <br /> (Please allow 10 business days from date of application submittal-'.Tentaffve only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST- 5r FEE(CASH OR CHECK ONLY) PCQ(JE$T PROCESSED IN 3 BUSESS D�,YS <br /> SIGNATURE OF APPLICANT <br /> --- --- DATE <br /> Electronic Information: E] List[I map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> -street Street NIM0 City Unit I <br /> A101M/ FAO�ZO <br /> b4o <br /> 2. <br /> 0 Unit <br /> 3 3. <br /> 4. Unlit <br /> Unit 114 <br /> 6. <br /> 7. <br /> 9. <br /> 10, <br /> Specific Date Range Of ltiformatlQd.Requested:Prom to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 3�(JkDERGRDUNv TANK(UST)CLEANUP SITE(LOP) M]HOUSING A'BATRIVIrENT r-QoLlo WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 F000 FACILITY WASTE TIRE <br /> R-INGIREMOVAL) 0 Doe KENNEL DAIRY <br /> AZARDOUS WASTE G;NFRArok El CHICKEN RANCH VVA$TCWAT[A TREATMENT PLANT <br /> ��TlEftrnNDER-GROUN0 TANK(MCNITO PERMITTED FACILITY M MOTEUNOTEL C PUMPER TRUCKIYAREVCHrM TOILETS <br /> IM TATTOO/Boot PmRcima 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECIFY)- <br /> VVrLL AND SEPTIC PgRMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY 8.00 AM5,00PM , EXCLUDING HOLIDAYS, <br /> I. List Up to ton addresses in tho space above. 'Select the type(s) of files from the list above by Checking the appropriate <br /> bOX(GS). At least One file typa.MUST be selected, Fax to(2I <br /> g 414-?1.111o,mail to the addresslrdjc�t�od above. Address <br /> ranges will not be accepted—for additional assistance with file addresses,contact the EHD.Applications rocaived after <br /> 3:00 pm wl 11 be processed the next business day. <br /> 2. Tho EUID Will notify the applicant if any r=HD files exist. An appointment for review will be confirmed app-roximately ton(10) <br /> days after receipt of application. Tho files will behold for a maximum of five business days for review. Appointments. <br /> should be scheduled accordingly. <br /> 3. A filo that Is actively being worked on by EHO staff may not be liTimodiately available for review. A new application may be <br /> submittad when the fife Is available. <br /> 4. Any file not mturnod in the same condition at r9fonsed will be reorganized by F_HD staff at the expense Of the applicant. <br /> Future file reviews by tile same applicant may require a$95.00 deposit prior to review.. <br /> FHD USS ONLY <br /> t"o-ig.06 9031200G <br />