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SLEMfI LC]G HUBABm <br /> v.Y�gE,;E:vEn /SAN ,)OAQUIN''COI�MTI PUBLIC HEALTH SEP-VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WERER AvET UE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> p �1� (209)'46$-3120 <br /> PUBLIC RECORDS RE EASE A�PPLICATIaN <br /> (1� YCAAPPLICANT - E1U$INESSIAGENCa� C <br /> ADDRESSPHONe <br /> FACSIMILE <br /> TE%ITATIVE*APPOINTMENT <br /> DATE <br /> 711M1= <br /> (PleaSe give I to 10 busincas d s from date of aPPliCat.an submrttal) <br /> CHECK BUX TO EXPeD TE RECIUE.S - FEE—REQUEST PFtOGESSEl7li13 BUSINESS DAYS <br /> YY` e - DATE �` t7 <br /> SIGNATURE OF APPLICANT v->, <br /> F ILL AooREs3 I I fl <br /> Q <br /> CI Ll 'to L7_T t�ho('`C p Q� <br /> t.t t t l rO IP "f <br /> a Ug :crtia � 4.r3t�-z -r,Pkt <br /> F l ENVIRONMENTAL IIH DIVISION FILES <br /> 1 ❑ SOLID WASTE FACIOTY <br /> NDERGRC UN TANK(UST)CLEANUP SITE(IAP} f3 HOUSING ABATEMENT ❑ SOUD WASTE VEHICLE <br /> V"=CLEANUP SITE(NON4LOP) ❑ FOOD FACILITY <br /> ❑ flaG KETiNEL. ❑ DAIRY <br /> C1 Ulil]ERGRC UIiD TANK(M41tilITORIi�tGli2E141UVAL) 13 CHICKEN RANCH I❑ PKG TREATMENT PL.A1,41 <br /> p HAZARGOUS wASTE GENERATOR p UOTEIJHOTEL ❑ PUMPER TRUGKIYARWCHEM TOILETS <br /> I3 TIERED pEItMITTED FACILITY d POOLISPA' ❑ LAND USE APPUCATUM SITES <br /> 0 TATTOOf1BKtl:►Y PEIRCING C3 PUBLIC WATER SYSTEM [3OTitER(PLEASE SPECIFY ABOVE) <br /> 171MEr"CAL WASTE FACILITY <br /> P <br /> 1. List up to ten addresses in the spaco above..Select the type($)of files from the list above by checking <br /> this appropriate box(es). At least one fits type MUST be selected. Fax to f209 4-1138 or mD!�_ <br /> dress Vindicated 211� <br /> adove•. <br /> Z EFID will notify the applicant it any END file$exist. An appointment for review will be CanfirTned <br /> approximately five business days but no later than tern(10)days after receipt of application, The files <br /> wi i be hold for a maximutn of five business days for review. Appointments should be scheduled <br /> aC Cordi n g ly. <br /> 3. A•'ile that is actively being Worked an by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the fila is available. <br /> 4 Arty fele not returned in the same condition as released will be reorganized by EHa stafl",at the expense <br /> of the applicant. Future file reviews by the Sarre applicant may require a $T8.00 deposit prior to review. <br /> 5, *TENTATIVE appointment dates must be...,jr <br /> with EHD staff. <br /> g. Applications received after 3:010 pm will be processed the next business day. <br /> k <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONS IRMEI7 PHONE FAX INITIALS <br /> 1 <br /> REVIEWED YES NO REVIEW DATE <br /> EH Ua iS Ot1as . <br /> 10 39Vd SS3�dX3 NNI AVCI30H 002T5S850Z 97 [0 ©90Z1�6l�T <br />