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v Axid : IkUUIN GUUNIYPUBLIC HEALTH ' RVICES I ^ <br /> of <br /> S� l jj \ IC � - NVIRONMENTAL HEALTH DMS. J Q )` <br /> W LS II JLC D 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 .7k>" A <br /> JUL 2 5 2000 {2D9} 468 420 r m 7+ 4 <br /> PUBLIC RECORDS RELEASE APPLICATION a <br /> APrF, _ Bce <br /> USINE$S/AGENCY ?dL1e2?, t20EJ7U/ND/� �YIP/7 tr� l ,�`I <br /> ADDRESS `7 p 5� LG/R/n( SD Q C CA Saps <br /> PHONE FACS_? ILE S� <br /> TENTATIVE' APPOINTMENT DATE % DD TIME <br /> (Please give T to 10 businasa ays from date of appllcMion submittal) <br /> CHECK BOX TO EXPEDITE REOU - 70,00 FEE - REQU PRO ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 'L DATE <br /> FILE ADDRESS <br /> 1 2 0 71 3 <br /> T� III <br /> JENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ED FOOD SO FOOD FACILITY UO WASTE VEHICLE <br /> UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ` TATTOO/DODY PEIRONG 1 p I ❑ POOLfSPA ❑ LAND USE APPLICATION SITES <br /> . y� MEDICAL WASTE FACILITY- I p W Q PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ASOVE) <br /> 1 . List up to ten addresses in Int spat above. Select the type(s) of files from the list ahoy® by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464.0138 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 be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application- The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 30 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 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 pin 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 ua u 81ffiWQ0 <br /> i <br />