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S; � iCOUIN COUNTYPUSUC HEALTH S ICES <br />�\ ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />EJUSINESSIAGENCY <br />ONE 16 '7;/ <br />4 La 40 FtACSIMrLE <br />/ TENTATIVE" APPOINTMENT RATE >/.I or— ��� a <br />(Please Biwa 7 to 10 busiteess days from d cat of <br />61x1l,rs J. <br />CHECK BOX TO EXPEDITI! HE <br />SIGNATURE OF APPLICANT <br />YJ+c: i.6C� kYy iiklt �'^� <br />n� stir ,, i"_ALIH <br />It) <br />TIME �i.J �,rlii,°, ii�;,,_i <br />r•�` <br />application submittal) 'I c i S <br />X. 7h�`S 1� �Oarr��ar`° <br />N 3 BUSINESS DAYS��� <br />UNDERGROUND TANK (UST) CLEANUP SITE SLOP) <br />0 HOUSING ABATEMENT <br />0 SOLIb WASTE FACIL" <br />OTHER CLEANUP SITZ= (WON -LDP) <br />0 FOOD FACILITY <br />Q SOLID WASTE VEHJCt <br />12CUNDERGROUND TANK (MONITORINOIREI OVAL) <br />0 DOG KENNEL <br />❑ DAIRY <br />ICHAZAtRDOUS WASTE GENERATOR <br />Q CHICKEN RANCH <br />0 PKG TRF-ATMENT PLANT ^^��// <br />0 PUMPER TRUCWYARDtCHEMTUCVTs2� <br />* TIEREiDPERMITTED FACILITY <br />0 MOTELMOTEL <br />* TATTOOIBODY FORCING <br />a POO1.j7SPA <br />Q LAND USFE APPLICATION SIT..S <br />� MEDICAL WASTE- FACILITY <br />E3 PUBLIC WATER SYSTEM <br />O OTHER (PLEASE SPECIFY ABOVE) <br />9. t.Ist 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 L0�) 464-0938 or mail to th <br />addrgss')ndicatgd above. <br />2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br />approximately five businozz days but no later than ten ('!0) days after receipt of application. The files <br />will be held for a maximum of five bu$Iners days for review. Appointments should be scheduled <br />accordingly. <br />3. Afile that is actively being worked on by EHD staff may not bo immediately available for review. A new <br />application may be submitted when the filer is available. <br />4. Any filo not returned in the same condition as released will be reorganized by END Staff at the expense <br />of the applicant, I~uture•fiie reviews by the :same applicant may require a $78.00 deposit prior to review. <br />5. "'TENTATIVE appointment dates trust be confirmed with EHD staff#. <br />6. Applications received after 3.00 pm will be processed the neXt business day. <br />A <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS -- <br />REVIEWED YE5 NO REVIEW DATE <br />EH Go ]t atroxao <br />.230 <br />