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SAN .}. .. tQUIN C:OUN <br /> �„ NV)'RONWENTAL HEALTH D(Visi <br /> tw <br /> MAR 3 2001 304 EAST WI=SER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (200)'468-3420 4 cl.1 <br /> �L�-H PUBLIC RECORDS RELEASE APPLICATION <br /> A I k A I :SMNESS/AGENCY <br /> 317 SA&uj RoaJ, Stnektg s I <br /> GSQ -IlL1 I-�1_� fie FACSIMILE f <br /> k' TENTATIVE*APPOINTMENT DATE��tiriA„� TIME �f]`'00 nv, -- <br /> (Please give T to ITbmin days from date of application w6mi'tUl) <br /> OD <br /> CHECK BOAC TO LXP%I DIT E RE+:JJF457 t,7 FE RE EBT P1iCG_1;SZeQ IN 3 BUSINESS BAYS <br /> SIGNATURE OF APFUCANT DATE � �� 0'1 <br /> F1a�AOT]RESS :„� <br /> rX fl Yy <br /> 1 A <br /> r �3Sez c. Irl L - <br /> ��s� T _ <br /> ENVIRONMENTAL WEALTH DIVISION FILES <br /> LINDERGROUND TANK(US"i'y CLEANUP SITE(LAP)' ❑ HOUSING ABATEMENT ❑ -501-10 WASTE 1=ACILffY <br /> G-rkjER CLEANUP SITE(NON-LOP) 0 FOOD FAC IL.IFY ❑ SOLID WAS-r>~V.t-HICLE <br /> UNDERGROUND TANK(MONITURWGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY a <br /> HAZARDOUS WASTE GENERATOR a CHICKEN RANCH .. O'PKG TRFATMENT PLANT <br /> ❑ TIERED PERMITTEE)FACZLITY ❑ UOTFUH01ML C3 FUIwPERTRUCIKIYARUCHEMTOILETS <br /> M 7ATT00I80DY PEIRCINC+ C] POOLMFA ❑ LAND USE APPLICATION SITES <br /> Q ME131GAL WASTE FACILITY � PUBL1C WATI:Ii SYSTEM ❑ OTHF-R.(PLF:ASI~SPECIFY A80VE) <br /> 1. Ust up to ten addresses in the.space above, Select the type(s) of isles from the list above by checking <br /> the appropriate box(es)- At least one file type MUST be selected. Fax to f2091464-0138 or mail t the <br /> atodress indicated above. <br /> 2 EHO will notify the appOcai tt if any,Elio files exist. An appointment for review V411 be Confirmed <br /> approximately five Business days but no later than ten (90) 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 wotkad on by EHD staff may not be immediately avallable for review. A new <br /> application may he submifted when the file Is a"ilable. <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 flee rnviews by the same applicant may require a $78.00 deposit prior to review: <br /> 5, *TENTATIVE appointment dates must be confirmed with EH❑staff. <br /> B. Applications received after 100 prri will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIMI_ <br /> DATE CONFIRMED RHONE FAX INITIALS <br /> REVIEWED YES NO _REVIEW DATE <br /> =k nu a 14mlffin <br />