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SAN AQUIN COUNTYPUBLIC HEALTURVICES tint <br /> ENVIRONMENTAL HEALTH DIVISION <br /> f /„ :304 EAST VVEDER AVENUE, THIRD FLOOR <br /> b b <br /> STOCKTON CA 95 02 <br /> I (209) 45a-3420 <br />' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT yWyVfP"y. / !✓Lfi5- BUSQfNESS/AGENCIY y1 ff f/L ; JiFin 9 ly zL pri7..��']� <br /> ADORESS y� 1 l .ice:c-y (fit r / ( t'(YryIQ <br /> FNONE.6 fF"�� y / 7Z- FACSIMII�LE �1 777 `:!� <br /> TENTATIVE*APP011iTMENT'DArE QC•-�Obe/- TIME 1;W <br /> tP lease gno Ito 10 ousiness day6 from dale of appYoat ion submittal) <br /> © Uw/T <br /> t CHECK BOx TO EXPEDITE REOL55T'�$ 0 FEE-REQUEST PROCESS 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> �i <br /> t FILE ADDRESS THIS SIDE PHU STAFF USE ONLY <br /> it j PROGRAM ELEMENTS SEARCH <br /> N <br /> - <br /> I <br /> ENVIRONMENTAL HEALTH DlY131ON FILES <br /> 0UNDERGROUND TANK{UST)CLEANUP SITE((•0P) ❑ MCU41NGAUATEMENT ❑ SOLID WASTE FACILITY <br /> 0THER CLEANIW SITE(NON-LOP) 2 ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ UNDERGROUNb TANK(MONITORING(REMOVAL) 0 DOG KENNEL ❑ DAIRY <br />). 0 HAZARDOUS WASTE GENERATOR 4 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERPAITTED PACILtTY D MOTEL MOTEL ❑ PUMPER TRUCKIYARO/CHEM TOILETS <br />�. C2 TATTO0f8ODY PEIRCiNG ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> L7 MEDICAL.WASTE FACILITY O PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> .I <br /> t- List up to ten addresses in the space above. Select the type(s) Of files from the list above by checking <br /> the appropriate box(es). At tease one file type MUST be Selected, Fax to(209) 464-0136 or mall tD the <br /> address indicated above. ,.py <br /> 2. EHD wilt notify the applicant if any EHp files exist. An appointment for review will be confirmed 0=5u111vi U <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will beheld for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. II KLS <br /> 3. A file that is actively beinelworked 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 fife not returned in the same condition as released will be reorganized by END staff at the expense <br />,I Of the applicant. Future file reviews by the aame applicant may require a ST8.00 deposit prior to review. <br /> i 5. "TENTATIVE appointment dates must be confirmed with END staff. <br /> 6, Applicationg received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> 9 <br /> DATE CONFIRMED PHONIT FAX INITIALS <br /> i RFtlIFN/Fn vcq <br /> J <br />