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LI:3..V1:c.Gll;l.ii <br /> SAjN--'e)AQ13IN.00UNTYPU5LIC HEALTF� "F--:RViCES Pt3Di <br /> ENVIRONMENTAL HEALTH IaMV1' <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> •STOCKTON CA 95202 <br /> �/� <br /> J U L 1 � �is�� (209) 46"420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESS/AGENCY <br /> ADDRESS <br /> PtIONE �d L1 FACSIMILE r _ -- <br /> TENTATIVE"APPOINTMENT 13ATL TIME <br /> I� (Pleaua give 7 to 1110`0 businn6*days tam data of appllva on sub"ttal} <br /> CHECK BOX TO EXF�CI7TTE F2!pUCs7-$7 0 F��fU£5T FROCIES5E;D IN 3 BUSINESS PAYS <br /> 1 <br />[ SIGNATURE OF APPLICANT _ �y - ,� —_ _ DATE <br /> FILE ADDRESS <br /> V*~o 35a a <br /> Xil <br /> 1 <br /> S <br /> 55 <br /> f <br /> ENVIRONMEt4TAL HF-A_TH DIVISION FILES <br /> 1UNDERGROUND TANK 03T)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTMrtR ClEANUp SITE(![ONiLOP) Q FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK 1MQNCTORlNGfRr=M0VA1.) 0 DOG KENNEL O DAIRY i <br /> HAZARDOUS WASTE GENERATOR 0 C 4ICKEN RANCH C3 PKG TREATMENT PLANT <br /> EITIERED PERMITTED FACILTiY ❑ M0TELH0TE3 0 PUMPER TRUCKIYARDlCHEIIETQILETS <br /> la TATTOOIRODY PEIRCING 0 PQ0Ll5PA 0 LAND 113E APPLICATION SITES <br /> a MEDICAL WASTE FAC11ITY Q PUBLIC WATER SYSTEM la OTHER[PLEASE SPECIFY ABOVE) <br /> • I <br /> 1. List lip to ten addresses in the space above. Select the types)of files frorn the list above by checking <br /> the approgriata bores). At least one RIO type MUST be selected. FAx t 09 464-M38 or mall to the <br /> address indicated Bbgyo. ' <br /> 2• EHD will notify the applicant if any EHfl files exist. An appointment For review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a MaXIMUIn of Five business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3_ A ffte that is actively bring worked on by I;HO staff may not by Immedlately available for review. A new <br /> application may be submitted when the file is available. 1 <br /> 4. Any file not returned in the same condition as released will be reorganized by IEHD staff at the expense l <br /> of U applicant. Vvture'file reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. 'Tl:.IdTATIVE appointment dates must bo confirmed with EBI]staff. <br /> a. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DA`FF- TIME <br /> DATE CONFIRMED RHONE FAX INITIALS <br /> REVIEWED YEs NO REVIEW DA'L'E <br /> Bf fXi 1� Q110.5Ak7 � <br />