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DATE i EIVED M4AN JO � R ES EMD LOG NUMBER <br /> 1, IV LJ NIMONMENTAL HEALTH DIVISION C < <br /> 304 EAST WEBER AVENUE, THIRD FLOOR f/� <br /> DEC 2 21999 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> NVIRuivlvl i�rAL r'EA%BLIC RECORDS RELEASE APPLICATION <br /> i <br /> APPLICANT i ,It l�h �,r .�(1� BUSINESSIAGENCY 2Idf1r + Ccs/ <br /> ADDRESS Y 0 !)>Z r) l) T1 �.�'i 5'T D c\<Z 1)ta Com, <br /> PHONE t / S " FACSIMILE `t )S- q,o 0 1 <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> 71 CHECK BOX TO EXPEDITE REQUEST- 8.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT p Q Q I DATE 7 2Z <br /> U FILE ADDRESS <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL In PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA C1LAND USE APPLICATION SITES <br /> 13MEDICAL WASTE FACILITY C3PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. 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 least one file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD 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 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 EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 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 I TIME <br /> INITIALS <br /> DATE CONFIRMED' ;r PHONE FAX <br /> REVIEWED, , YES Nor REVIEW DATE <br /> 8130,99 <br />