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la:via-tr rK!r TO <br /> 191678268,16 P.02 <br /> SAN J 'UIN COUNTYPUBLIC HEALTH SE `CES <br /> rNARONMENTAL HEALTH DIVISION". <br /> F <br /> 304 EAST WEBER AVENUE,THIRD FLOOR � J <br /> STOCKTON CA 95202 I LL <br /> J Q LL <br /> ATE (209)468-3420 o T_ U <br /> PUBLIC RECORDS RELEASE APPLICATION o <br /> n._!. <br /> APPUCANT HtC9t_ T AW94%n2g� RUSN"WAGENCy syAx/i6 Qa'r>•'Y.i/sv/G/-L 5 ,c <br /> ADDRESS SaZ ! {/ {!�'j -sSL ml z <br /> PHONE /C 5��2� FACSlltILE _ �` 'r{ 1 @ t 0 T. <br /> TENTATIVE*APPOINTMENT DATE_ Z�, -ZII TIME9 Z <br /> ._._..__If __._.._� <br /> (Please give 7 IO 10 business d s Ir///gn date Of application su"gtll) _LL Lu <br /> 0 CHECK COX TO EXPEOITE REQUEST-STa.oa F HCICESSED 3 CUSiNESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> tar'6& 419 <br /> N <br /> L <br /> ENVIRONMENTAL H THDIVISION FILES <br /> UNOFRGR0UHD7ANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ASATEMcNT ❑ SOLID WASTE FACfLrrY <br /> ❑ OTHER CLEANUP STIE(NON-LUP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> C2 UNDERGROUND TANK isIONITOIRINO/R6150VAL) ❑ DW KENNEL O DAIRY <br /> a HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMIT?&D FACRTTY '.7 NOTFIAIOTEL ❑ PUMPER YRUCX/YARD7Gt1EM 7UILETS <br /> ❑ ME06CATATTOOWAS PEFACILI =' PODUSPA a LAND USE APpUCAT1ON SITES <br /> Q MEDICAL WASTE FACILITY Q PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to tan addresses in the space above. Select the type(s)Of files from the 1191 above by checking <br /> the appropriate box(es). At least one filo typo MUST be selected. Fax to(2091464-0738 or mall to the <br /> address indicated ebgXe <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 aPPRiaatlon. The files <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> a. A file that is actively being worked on by EHD Staff may nat 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 578.00 deposit prior to review. <br /> 5_ *TENTATIVE appointment dntaz must be oafrmed with EHD staff. <br /> 6. Appll"hons received after 3:04 pm will be prof®sled the next bueiness day. <br /> CONFIRMED APPOINTMENT DATE M1 TIME <br /> DATE CONFIRMED _ _ PHONE FAX INITIALS f <br /> REVIEw>=D YES NO , REVIEW DATE <br /> TOTAL P.02 <br />