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Dec 08 04 02 :37p Hanover Inc 530 342 <br />19T-b.!—tYJUk� tic. j. oru . ..v. . <br />f ,®ats ,n ''cuT��' Jt��1GtUlN COUNTYPUBL.IC HEALTH 5BR1� . ES <br />�j ENVIRCiNMENTAL HEALTH DIMIOIN <br />DEC$ 2004 304 EAST WESER AVENUE. THIRD FLOOR <br />STOCKTON CA 98202 <br />(los) 468,U20 <br />BUC RECORDS RELEASE APPLICATION <br />APPLICANT =1 <br />ADaREss tQ= <br />PHONE FACSIMILE" <br />.0 lac, <br />4ar-aude,r S-�. <br />•^ BUSINESslAGENCY •J <br />TENTAnVE* APPOWMENT DATE "4 f J-;' 104 - -- TIME <br />(Plaaae give 7 to I USIMS days from date of applecetlos+ suemkttan <br />p CHECK BOX TO EXPEDITE REQUEST - #$7.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT Y..' DATE tx /0 - <br />y:?a+ E. {--M"Jovtt S+., r <br />N• An+gyros 1 <br />21c3P Si -1 - <br />utsT <br />'77C. Came <br />i <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />uNUERoROUND TANK (UST) CLEANUP SITE (LOP) ® HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br />/OTHER CLEANUP CLEANUP SITE (NON -LOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br />,UNDERGROUND YANK (MONM=NGIREMOVAL) 17 DOG KENNEL 0 DAIRY <br />fl HAxARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />O TIERED pLRMiTTED FACILITYa MOTEL/HOTEL _ O PUMPER TRUCKNARDICHEM TOILETS <br />O TAiTODf80DY PEIRCING C3P60USPA G LAND USE APPLICATION SCFES <br />0 M"ICAL WASTE FACILITY 'D PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPECIFY ABOVE) <br />7.kin <br />List up to ten addresses in the space above. Select the type(s) of flies from the fist above by ch o the <br />the appropriate box(es). At least one lite type MUST be selected. Fax to f Q9) 4G4 -t)938 or mail to the <br />'I,Wresa in i aced bovEe. <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 />wil� be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A fik'tha,t is actively being worked on by EHD staff may not be immediately available for review. A new <br />appil"tion may be submitted when the file is available. <br />4. Any film 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 sante applicant may require a $87.00 deposit prior to review. <br />S. *TENTH -!VE appointment dates must be confirmed with EHD staff. <br />fi. Applicati��;ns received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPO10TMENT 6A'rE TIME <br />DATE CONFIRMED PHONE FAX • INITIALS <br />REVIEWED YES NO REVIEW DATE <br />