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i <br /> SAN f,.)QUIN COUNTYPUSLIC HEALTH S,.)VICES <br /> l� ENVIRONMENTAL HEALTH DIVISION /I <br /> n1,V(tl\ f 304 FAST WEBER AVENUE,THIRD FLOOR ?T <br /> STOCKTON CA 95202 <br /> (209)468-3420 ✓ <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ✓/N 6e9;_G—' _ BUSINESSIAGENCYGlOUlW[PO <br /> ADDRESS <br /> PHONE Z9, 5qar1 _1011111FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from dale of app0cation submittal) i A 1 2 5 2001 <br /> 4q� CHECK BOX TO EXPEDITE REQUEST- 7 0 r- QUEST PROCESSED IN 3 BUSINESS DAYS I. �Vi <br /> (1\Jf-� �'� P` it I Q1: <br /> SIGNATURE OF APPLICANTDATE Z 207 <br /> { <br /> /FI ADD :Y- <br /> ( Ra <br /> t <br /> in'A LV- <br /> 3s zC. <br /> all - 3W29_ <br /> C 3 5 7.g <br /> ODA CIA ;2 S <br /> a9 M_ <br /> S l ct� v t 3 5-2 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY I <br /> OTHER CLEANUP SITE(NON-LOP) ❑ r-000 FACILITY Q SOLID WASTE VEHICLE 11 <br /> UNDERGROUND TANK(MONmORINGlREMovAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERmrTTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEiRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC 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 alcove by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)484-0738 or malt to the <br /> ar ,dress 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 i8 available. <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant Future'fiie 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 /> CONrIRMER APPOINTMENT DATE TIME <br /> DATE CONFIRMED - PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ai DD 14 41IDIND , <br /> t!� <br /> I <br />