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OAr4 JVA' 'JIIY 4VUIVIYYUtSLIti 1itALIt-I 5lwKYlt�t� <br /> E�RONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR N,,e <br /> STOCKTON CA 85202 <br /> (209)468-3420 <br /> } � v PUBLIC RECORDS RELEASE APPLICATION LQ <br /> APIRLICANTi��, �CbI^ 0USiNkSS/AG8NGY �h'1�rte. Y►YO IYrI�YI fes-[ i�1� tjcn <br /> ADORgsS 2�70 Ife.ricinS - 6 ' SOnar+r•2L CA 954-712 TC:D ¢`D <br /> PFLQNr4 t-ta-1FACSIMILE ro k7A+9 <br /> U-1 u^ <br /> TENTATIVE*APPOINTMENT DATE Weck, �Tky1. 24 -nma 10" 00 aOA- <br /> (Please give 7 to 10 busincss days from date of application submillal) <br /> U5 <br /> Eal"CHECK BOX TO EXPEDITE REQUEST•S87.00 FSE-REQUEST PROCESSED IN 3 BUSINESS DAYS FOE w <br /> SIGNATURE OF APPLICANT DATE I- Z2.—G 1 <br /> F1L.>=ADDF2E55 THIS$[DE EEO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> M2401) 1501 l�►1fX+ Kc%1,fYtViq ;-OA; d �2 <br /> u� 2t�yLSl,,r � +}•o� ac Jr 1C�t4lemrY, txr� l..od i � <br /> LA-Z <br /> 4 <br /> � ENVIRONMENTAL HEALTH DIVISION F=ILES <br /> M UNDERGROUND TANK(LIST)CLZAIAUP SITE(LOP) 0 HOUSING ABATEMENT ❑ $OLID WASTE FACILfTY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY L7 SOOD WASTE WHICLE <br /> !O QNVERGROUND TANK(MONITORINGIREMOVAL) Cl DOG KENNEL ❑ DAIRY <br /> O HAZA8.DOUS WASTE GENERATOR. O CHICKEN RANCH fl PKG TREATMENT PLANT <br /> ❑ TIERED PER:arr Eo FACILITY Q MOTELJHOTEL Q PUMPER TROCKIYARDfCHEM TOILETS <br /> 1:3 TATTODISODY PEkRCiNG ❑ POOLlSPA ' - O LAND USEAP,PLtCATIoN siTEs <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY•ABOVE) <br /> 1. List up to ten addresses in the space above. Satect the type(s) of tiles from the list above by checking <br /> the appropriate box(es). At teast.one fiic type MUST be selected. Fax to (209)464-0113a or malt to the, <br /> address indicated abgve. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately live business days but no later than ten (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A novo <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in th$same Condition as released will be reorganized by EHO staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review, <br /> 5. *TENTATIVE appointment dates rnust be confirmed with EHD staff. <br /> fi. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATZ CONFIRMED � PHONE FAX INMALS <br /> REV IByaV YES NO REVIEW DATE <br /> 4WH Ga I'S ,osw ne - - <br /> TOTAL. P.61 <br />