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SAN i0f no cis <br /> IRONMENTAL HEALTH 01VISIM40ii) <br /> 'YE <br /> 304 EAST VVF-13ER AVENUE.THIRD FLOOR 1 <br /> STOCKTON CA 95202 <br /> (209)466-3420 jEi <br /> 0200- <br /> 0 <br /> I?UBLIC RECORDS RELEASE APPLICATION <br /> EIUSINESSIAGENC <br /> y <br /> AFFU <br /> CANTS Mail <br /> ADDRESS L10 <br /> PHONE <br /> bl,LO rACSIMILE <br /> ENTDATE vimE 61n.- <br /> TENTATWE�APPONTM t)"&days frorn date of P111600r%submittal) <br /> tPleaSe give 7 to 10 bVSih"& aFP *r= ro te <br /> i " <br /> 78.00 FEE RF_, ST PROCESSED IN 3 BUSINESS DAYSpLr_ <br /> CHECK BOX To EXPEDITI: QU DATE Yvilu*Flckp <br /> SIGNATURE OF APPLICANT <br /> IV <br /> f:,LF AuDqrzss <br /> C_ <br /> 55 <br /> AST_ Lilhii', _ L <br /> 0 <br /> '76 Y L1 S <br /> A� <br /> fE <br /> dr j�pDENUIRIC, TAL HEALT DIVISION FILES <br /> UNDE r RGROUND TANK(UST)CLEANUP SrI'L(LOP) 0 HOUSING A T ENT M SOLID WASTE FACILITY <br /> 0 FOOD qACIL c soLiDWASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) EL 0 DAIRY <br /> In PRG TREATMENT PLANT <br /> P <br /> UNDER(3,1ROUND TANK(MONJITORNGIREMOVAL) ICK� <br /> HAZARDOUS YVA OR T N [I PUMPER TkUCKfYARD/CHEM TOILETS <br /> 0 TIERED PERMITTED rACILITY p LA14D USE APPLICATION$ITES sEPTIC- <br /> 0 TATTOO1130DY 1,F;IRCINL+ FOQIJSFA %0THEFz(PLEASE SPECIFY ABOVE)WF_1,L1, <br /> S'rr=GENERATOR EL <br /> pVBLr.WA'rrR YSTEM <br /> M MEDICAL WASTE FACILITY --king <br /> I List up to ten addresses in the space above. Select the type(s) of files from the list above by chil to <br /> or mao the <br /> the appropriate bGx(e5). At least one file type MUST be select!ad. <br /> addre a�jnd�jcatedabove_ irrined it <br /> EHD will notify the applicant IF ijVy EHD files exist. An apoointment for review <br /> iOw will be conr <br /> 2. approximately five business days but no later than ten ('10)days after receipt of opplicati6n. The files <br /> will be held for a maximum of five business days for review. !Appointments should b.e scheduled <br /> accordingly. or revi w. A new <br /> 3. A file that is actively being worked on by EHD Staff may not be immediately available f <br /> application may be submitted when the file 15 avallable. .E; f at the expense <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD sta f <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit pr.ior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the.nal t business day. <br /> TIME <br /> CONFIRMED APP(031NTMENT DATE <br /> INITIALS <br /> DATECO IRMED PHONE FAX <br /> ATE CONFIRMED <br /> REVIEWED YES NO REVIEW DAYIw---- ------- <br />