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oaffi Rsry.+vcn L=dj l,h:t:VD6.t�{ riJ <br /> SAN AQUIN COUNTYPUBLIC HEALTH 10MCF-S <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WF-BER AVENUE,THIRD FLOOR <br /> STOCKTON CA 05202 <br /> (tog)08-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT <br /> ADDRESS <br /> FACSIMILE 3 z <br /> TENTATIVE"APPOW17MENT DATE TIME <br /> (Please Sive T Go SO business days ft date of aflpticavon submival) <br /> ED GHEGK ESOx'I'O E7CM01TE REQUE5T-S78.00 FEE—REQUEST PROCESSED iN 3 BUSINESS DAYS FILE <br /> CGFY <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS .0 <br /> 97 c <br /> 4 �u1 ry <br /> .S iGA2 49 <br /> ENVIRONMENTAL HEALTH DIVISION Fll_ES zr <br /> vk [.,,—, s <br /> UNDERGROUND TANK(UST)CLEPWtIV SrM(WP) O HOUSINGAfiATEMerr 50LID WASTE FACILITY 5 <br /> EITHER C:t kANt1P SITE(HON-COP) Q FOOD FACILIW SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MOMMOWNWIRX-I4 0VAL) El 04G�NUEL ❑N RANCH DAIRY <br /> AIFKG TREA?MENT PLANT 1 S� 5 S <br /> TMIZE <br /> HAZARDOUS PERMIWASTTTED <br /> GENERATOR ❑ MOTELIHOTEL pUTAPERTRUCWYARDI:HEMTOILETS <br /> L7 TLERED FERMI'iT6D FACIL7iY (,,, <br /> 0 TATTOOMODY PEIRCING C] POOLISPA LAND USE APPUCATION SITES 4 0 <br /> MEDiCA.L WASTE FACILITY ❑ PUBUC WATER SYSTEM OTHER(PLEASE sPECIFy ABOVE) j <br /> 1. L,iSt up to ton addresse-s in the space above. Select the type(s) of files fro ist a + v cYlecicing <br /> the appr+opriarte box(es). At least one Fie type MUST be selected- Fax t f 09 464-0938 Qrs"il to tlto <br /> addro§§indleated above. <br /> 2. EHO will notify the applicant If any E;HO files exist. An appointment for review will be confirmed <br /> approXimately five business days but no later than ten(10)days after recelpt of application_ The fifes <br /> will be hold 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 is available. <br /> 4. Any file not returned in the same condition a$released will be reorganized by EHD staff at the expense <br /> of the applicant- Future file reviews by the same appliCAnt May require a$78.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be conTIrMed with EMD 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 /> l REVIEWED YES NO REVIEW DATE t� <br /> er+vi ++ o+mstvo <br /> TOTAL N.02 <br />