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rtl = Geo Cnvironrnant-I Inc- FAX NO. : 2F39S690295 tt3-r. Oc ?001 1�:SbPh1 P2 <br /> �'� , E�ou roc que11 <br /> I v� <br /> SAN J16 -QUIN COUNTYPUBLIC HEALTH SE�ICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR Q 5 2*1 304 EAST WEBER AVENUE,THIRD FLOOR <br /> 02 <br /> Y STOCKTON CA 95202 <br /> ENV1R N - =/ � (209)46B-3420 <br /> ITI; ES PUBLIC RECORDS RELEASE APPLICATION <br /> 'APPLIQ6 A<<fe d `` <br /> p .. r7.�d'�xrran <br /> O E FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME 7$ <br /> (1110ase give 7 to 10 business days from date of application submittal) <;,rr � <br /> CHECK BOX TO EXPEDITE-REQUEST-p Vo FEE—REQUEST PROCESS ED INj SU51XFSS DAYS <br /> SIGNATURE OF APPLICANT OATS' 2�1� �/ <br /> FILE ADDRESS <br /> o .Cello ,r ,s ... L T�v ¢�N ;r..z g <br /> 1 S 3r "1 3S z 7 <br /> i <br /> f r- <br /> ENVIRONMENTAL HfEA'LTH DIVISION FILES <br /> 9< UNDERGROUND TANK(UST)CLEANUP SITE(LOA) ❑ HOUSING ABA-rEmENr ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE INON-LOP) d FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> >�UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> G HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Cl TIERED PERMITTI»D FACILITY CI MOTELIHOTEL G PUMPER TRUCKfYARDICHEM TOILETS <br /> E, TATTOO14 ODY P✓`IRCING ❑ POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE F=ACILITY O PUBLIC WATER SYSYI=m ❑ OTHER(PLEASE SPECIFY ABOVE-) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the ilst above by checking <br /> the appropriate 1 t*X(es). At least one file type MUST be selected, Fax to (209)464-0168 or mail to the <br /> address indicated_above. <br /> 2. EHD will notify the applicant if any EHO files exist. An appointment for review will be confirmed <br /> approximately five business days but no tater 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 new <br /> application may be submitted when the file is available. <br /> 4- Any file not returned in the same condition as released will be reorganized by 1=140 staff at the expense <br /> of the applicant. Future file reviews by the same applicant may regaire a$7$.00 deposit prior 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 next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES no REVIEW DATE <br /> EH 00 14 05MSift -- <br />