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Nftpoll (- <br /> 07-17-2401 01:30PM FROM TO 19252835121 P.01 <br /> sAr. sOAQU'N COUNTYPUBLIC HEALTH SERVICES <br /> E:NVtRC➢1+MENTAL HEALTH DIVISION <br /> I '304 EAST k`�EB�R Avt~NUi=.THIRD FI:4CJFx <br /> a .SEP 1'2 A19 '8 26 STOCKTON CA95x02 <br /> (209}468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ;APPLICANT f= Y'V\Y� Y Sll$11�ES51AOENCY (r1 I ,�O •�jC��{ ��i t <br /> P>iacv��i�l�.�� Q`-I u - 2.�''��, >=AcSIA1Il.1=�C{Z.ri� �W�1•-Z�`'l5 <br /> TE.MTA71—iVE1 APPOiTiiietFhl"i DAYL_ t'�q �1 p bk •` <br /> t roue «=Da AM • <br /> (PIC: m av o 7 in 10 bvSinCssdays from date of a icst�on s ubm:�taa1 <br /> t--11 <br /> ' CHECK I3QX Tb EXPEpfTE RIr4UZ:5 -$87.U4 EE_FEpIle S3l;D iN SUSLPiESS DAYS-SIGNATURE OF APPLICANT GATE <br /> ; <br /> FIL14 ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAfA ELEMENTS$$ARCH <br /> 4L t <br /> l l C 3s � U f{UOIJS/�� <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0UNDERGROUNOTANK(US'I)GC�+sIUFSITE(LOP) ❑ HOUSIHGABATEMEHT C3SOLADVVA8'rEFACILITY <br /> OTHER CLEANUP SITE(NON-LOP) • 3 . 0 F000 r-ACILITY ❑ SDtJl)WASTE VE111CLE <br /> -UNOHRGROUHO TANK(Mti"I ORIgGrkr-_MOVAL) C1QQG KEHHEL a DAA <br /> {AZARi70U3 YVAS`7E GENERATOR C3 CHICX6N PANG)`1 t:5 PK07REAtMENTPLANT <br /> p rreritEO PEFthIFTTED FA'ILrry j d MCTIWHOTII, C7•PUMPER TRIiCiC1YAR!]rC14F.E{TOILETS <br /> ❑]'rATMaBQQY F EIRGIKG 1O P001J3PA '-, b LAND USI:APPLICATIPM SITfS <br /> M I18EDICAL wAzT-W FACtL3rY D PUm.IG WA,(ER SYBTEM ❑ OTHER(PLEASE 9PEC1FYA80VE) <br /> 1. Last up to tgn actclresses irl the spa;cq apovo. Select the types)of flies from the list above by checking <br /> the appropriate box(ca)_'At least one file type MIDST be selected. _qz to (209) 4'64:Q1_30.or mail to tha <br /> 1 Rddrais ind(cated abovel <br /> 2. F-14D will notify the applicant If any END files exist. An appointmenj for review will be Confirmed <br /> approx]m tely five bu$i6ess days but no later than ten(1a) days after receipt of applicaUan.-The dies <br /> will be hold for a maxirnum of five business days for revlew. Appointments should be Sahedulad <br /> accordingly. <br /> 3. A fila that is activety bsing,workcd on by L-ND$taff may riot be immediately avaitabla forrev;aw. A new <br /> application may bQ subrriltted when the file is aval(ablc. <br /> �• Any fife not returned in*c same condition as released will bo reorganfzed by EJ-1D staff at the expense <br /> Of the applicant. Future file reviews by the Samw alipticant Maly requtro a$07,00 deposit prior to review, <br /> $• ''TENTATIVE appalntmerit dater mustbe confirmed With AHD staff <br /> 6, ApplicooM5 received Ofi8f 3'00 pm will be processed the next bli's <br /> D&PIRMED APPONTMEHr bArE TIME <br /> ZATE.CQPIFiF'cNiEp PHONE FAX INITIALS <br /> REV14VVFZD YES f�O <br /> + .vsrorroo RcV]tW DATE <br /> TOTAL P,01 <br />