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V (1 l L �1, J VICESU1N COUNTYPUBLiC HEALTH EM)lOC.NUMUEI! <br /> � ' v IN <br /> VIRONMENTAL HEALTH DIVtSI <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> DEQ 1 2w STOCKTON CA 95202AV- 11 <br /> ENVIR(1N;,,n (209)468-3420 <br /> �r�;, r4 UBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT_!'2_(i✓,�YZG�(iG BUSINESSIAGENC'Y. �'/f„ &6mlo/` <br /> ADDRESS "PV lid' y �Z <br /> PHONE' l 2 G`�/ h FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (Please give T to 10 business days from date of application submittal) <br /> 2 Ar <br /> ® ,CHECK BOX TO EXPEDITE REQUEST- <br /> $09.00 FE REQUEST P CESSED IN 9 S ESS DAYSIII LA' , -, 0 Lf <br /> + 13 <br /> SIGNATURE OF APPLICANT DATE 4Z <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> nn nA Rn rf c;?rr=r <br /> o <br /> 1 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 911"UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> O OTHER CLEANUP SITE(NON-,LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> M-16 NDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> O. TIERED PERMITTED FACILITY O MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM YOILETS <br /> O TATTOO/BODY PEIRCING ❑ POOUSPA O LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM O OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to'ton 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 (209) 464-0138 or mail to the <br /> address 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 ton (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'availabie 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 reloasod will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $89.00 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 /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />