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Us.i c k"&yCU i:VAi wu•.ver.:-w <br /> N At JOAN COUNTYPUBLIC HEALTH SER" <br /> a. > <br /> EN P.ONMENNAL HEALTH DIVISION ' <br /> �- 304 EAST WtrBER AVENUE,THlftD FLOOR '. <br /> STOCKTON CA 95202 <br /> (209).468-,�420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT fkY�!_ - C[ : BU8INMS1AGENCY <br /> ADiSt SS � G G7 C <br /> IytiOl[E .q t `7 13 T' .r _ FACSIMILE <br /> TENTATIVE"ARp41NTmENY oATI TIME MD]/�'1 <br /> (Please givfl 7 to iQ bus' "a days 6viA date of application aubmttni) <br /> 9-CHECK SOX TO EXPEDITE REQUEST QOCESSE13 IN S BUSINESS DAYS � • <br /> SIGNATURE OF APPLICANT DAT£'' <br /> FILL:ADDRESS <br /> QL7, <br /> r <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> i <br /> 9-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) fl HOUSING AS'ATEME?tT 0!r-501_0 WASTE FACILITY <br /> OC OTHER GLEAwup$ITE(NON-LOP) EI FOQO FACM Y = SOLID WASTV.VEHICLE <br /> IEtmEfiGROUND TANK(AI0Al17QMNG/Fi_M0'lAL) ❑ DOG tcENPiEqL O DAM <br /> 4nVAZARDOW WASTt?GENERATOR <br /> C1 CHIMER RANCH In PKG TREA-TMEKT PLANT <br /> a�P_IJ69PERSRUCliiY DfCHETlT01L.�S <br /> 0 TATTOOrBODY PEIRGING 0 F QQUSPA` AdiLi USE APDL[CATIO 'S1 F <br /> S3 NSSD3CAL MASSE FAl�iti{.ITY fR_l?UBLIC WATER SYSTEM M OTHER OXFAG SPECIFY ABOVE) t <br /> ' r <br /> 4. hist up to ten addresstS in the space above. Select the type(s)of files froln the Ilst abave by CheCjong <br /> the appmpripte bax(es). At least One file type 16I0ST be selected. F2X W(M)404-0f38 o'r Mail to t <br /> ht <br /> aagYA55 Indicatedjk4V9, it <br /> 2. EHO will notify the applicant if any EHD files exkk-An appointment for revieavwl)i tW-colifilTned <br /> approximately five buslness days but no later than tan(10 days after recelpt of application. The blas <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> aacnrdingly. <br /> 3. A file that is actively being viroeKod on by EH staff may not he immadlataly available for review. A new <br /> application may be submitted where the file is avallable. <br /> a_ Any file nat returned In the same condition as released wilt Era reorganized by END staff it the expense <br /> of the applicant. Fwure file revlaWs by the same applicant may require a$76.00 deposit prior to review. <br /> 5. "'TENTATIVE appointment dates'must be contlrlried wltts i~Hb staff. <br /> 6. ApplicatiionS reaelved after 3:00 pm will be processed the next bLismass day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX IWIALS <br /> RLVIEtIV>rf3 YES NQ - REVIEW DATE <br /> I <br /> TOTAL P.W t <br /> k <br /> r <br />