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..N'z_-v-22-02 02_04P Herst & Associates, Inc. 636-939-9757 P.02 <br /> Jn.l'IILW,.VIU <br /> WAQUIN COUNTYPUBLIC HEALTH SEIVICES Dlo`tiG m'(KA <br /> ENVIRONMENTAL.HEALTH DIVISION <br /> v 304 EAST WEBER AVENUE,THIRD FLOOR ` 1073 <br /> STOCKTON CA 95202 <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> • oIMON <br /> APPLICANT BUSINESS/AGENCY � !/��•/A"1g �l�' <br /> 9 - - Cts /770 'r <br /> ADDRESS/�/ /�, /��/ <br /> PHONE 11 _%"` Aq-V// FACSIMILE (O& <br /> TENTATIVE*APPOINTMENT DATE TIME <br /> (phase gNa 7 to 90 businass deys from date of applies plubai) <br /> Li C= <br /> Q CHECK BOX TO EXPEDITE REQUEST•$69.0R ESSEL D <br /> SIGNATURE OF APPLICANT T <br /> DATE <br /> FILE ADDRESS THIS SIDE EMD STAFF U31!ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> L <br /> !AV ra 06 <br /> ENVIRONMENTAL HEALTH DIVISION FILES a S w leg <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLO WASTE FACILITY <br /> Lk OTHER CLEANUP SITE(LION-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(1MONITORINWREMOVAL). 13 DOG KENNEL O DAIRY <br /> D HAZARDOUS WASTE GENERATOR O CHICKEN RANCH X PKG TREATMENT PLANT <br /> Twkxv PERMITTED FACILITY O MtOTEUHOTEL O PUMPER TRUCKKARDICHHM TOILETS <br /> O TATTOO1800Y PEIRCING O POOIISPA O LAND USE APPLICATION SIMS <br /> D MEDICAL WASTE FACILITY O PUBLIC WATER SYSTEM 0 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 chocking <br /> the appropriate box(es). At least one rile type MUST be selected. Fax to(2091464-0138 or mall 12 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 flies <br /> will be hold for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that.)s actively boing worked on by EHO 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 as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by 0%same applicant may require a 589.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must bo confirmed with EHD staff. <br /> G. 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 `r <br />