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ii Y j <br />a,►'t>rit�r.�sv�a jl# �iSq�rrGlYIfAREFFt <br />SAN JOYWIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION /2 (,�y <br />J J 3t4 EAST VYESER AVrNIIE, THIRD FLo0R <br />STOCKToN CA 9=2 / �U <br />f b (209) a88-4,20, (� <br />PUBLIC RECORDS RELEASE APLICATION <br />APPLICANT BLSMES&AGENC"Y <br />ADDRESS <br />I& <br />10— -ka- <br />S2- <br />311 beninxi) <br />2. <br />PHONE: 2.oq w 2.3 - os"! FAG5164LLE_ gal -13-4. — b <br />TENTATIVE" APPDIAITmENT GATE <br />(Plsrase give 7 WIG busine's days Train date Df apt <br />QAJ ITS S <br />CtIECK sox TOEXPEUIT>= REQUEST - sar.oa F -Els=qu�sr I;ii C16 Iiia <br />SIGNATURE OF APPUCANT <br />Submittal) <br />DAYS <br />DATE 8 S t a`1 <br />��. <br />ENVIRONMENTAL HEALTH DIVISION IFG-ES <br />UNDE=RGR0uAID TAkK (USM CLF.ANUp &yg (LOP) 13 k "INC ABATEMENT 1 M SOLID WAWM FACILM <br />5r-DiNi R CLEANUP WEE (NOR -LDP) 0 FOCO FACILITY Q som WASTE vcmrLE <br />HAZARDOUS WASTE GENERATOR CF1[CKSM RANCH 0 pXG TREAT3NEW PLANT <br />❑ TIERED PEIiMn-W13 FACIIJTY CI Jt11oTELIHO7FEL t3 PUMPER TRUCK,tYA1WX rEKTOILETS <br />10 _TAATTOOMODY PEIRCiNG 13 P60LJ PA 0 LAND WE APPL=ATmN SITES <br />W- MEDICAL. WASTE FACUJTY 0 PUSLJC WATER S=EM CI OTHER (PLEA3E SPECIFY MOVE) <br />1. List up to tan aiddrayses In the space above. Select the type( -5) gf files frain the list above by checking <br />the appropriate box("). At least one file type MUST be selected. Fax to (209146."138 or mail tp the <br />address indicated abg '� <br />2. EHA will notify the applicant W;46y EHD flies exist An appoir���ent tor• review will be confirmed <br />approxhVately rive business days but no later than ten (10) days' after receipt of application. The files <br />will be helot for a maximum of five business days for review. Ap�olrtttt ents should be scheduled <br />acwr�din*. <br />3. A file that is actively being worked on by EHD staff may riot be immediately available for revlew. A new <br />application may be submitted when the file is available. <br />4. Any file not returned in the samo condition as rel=pd will be re <br />>arganked by EHD staff at the expeTise <br />of the applicant: Future file reviews by the same applicant may iequire a $87.00 deposit prior to review. <br />5. *MNTATIV� appointment dates must be confirmed with EHD staff. <br />z_ Applications received after 3:00 pm will be procw;sed the next busines$ stay. <br />11 <br />'ONFIRMED APPOiMMea DATE <br />)ATE CONFIRMED PHONE FAX !e INITIALS <br />k <br />i <br />