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SAN JC__4UIN COUNTYPLIaLIC HEALTH SL-rc%IICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> -304 EAST WEBER AvEfiUE,Ti-iIRD FLOOR <br /> STOCKTON CA 25202 <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> .APPLlCAN7 BUSUVESSIAGENCY ACA <br /> .:AD <br /> DRESS <br /> '�.�c�� CQD l -7- <br /> �`FAr31AVLL' <br /> i <br /> TENTA7tVE-APPOWTMENT'DATe���-.O`[ Jt TIM@ 0,n ` —e Y-n . <br /> (Plca11 1,75 <br /> a give 7 to 70 pusin¢ss pays from nate of sppl)callOn E4t«tiatel) c te"7� <br /> CHECx 80X TO a:xPEDRE rtE4VEST ,Dp FEE-f{EQ ST P1iOCE39P171N 7BUSINESS DAYS <br /> SIGNATURE OP APPLICANT DATE <br /> ` 49� <br /> FILE ADDRESS - THIS SIDE END ST4rF US 6 OHL <br /> PRPGRAM LLeMENTS 3 C <br /> e ' <br /> vl <br /> a <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> !VNp ERGROUND TANK(UST)CLEANUP$ITE(LOP) ❑ HQUSING AaATEMENT SOLD WASTE FACILITY <br /> OTHER CLEANUP SITE pIDN•LOPj O FOOD rADILITY OLID WASTE VEHICLE <br /> uNDEftDRDunD T4Nx(tgp NITDRINGIFPIADVAL) ❑ OQG KENNEL ❑ ,1DAMY <br /> HAZARDOUS WASTE GcHERATOR ❑ CHICKEN RANCH O PKGTREAT► NTPLANT <br /> TMr, MOTELdNOTEL 0 PUMPERTRNCRfYARDICHEMTOILETSD P001.ISPA -- - O LAND VSE APPL7cAT10N SRtis <br /> EDICAL WASTE FACILITY 6 PU811CWATERSYsTem M 0Th[FR(PLEASe9AECIFYABQVE) <br /> 1. List up to on addras"S in the Space abave. Select the type(s) of flips from the Ilst above by checking <br /> the appropriate box(es).'At least ane file We MUST be selected. Fax to (209)464-0738 or mail to tho <br /> dress indicated above! -- <br /> .2 EHD will notify the appliyant If any EHD files exist. An appo)ntment for review will be confirmed <br /> approximately frve busirn;esS days but no later than ten(10)days after receipt Of application.•The illes <br /> will be heid for a maximum of five business days for revlaw. AppoirtUnants should be scheduled <br /> accordingly. <br /> 3. A filo that is aotivol bai <br /> a "Canon y ri Worked ori by EHD S[a-I I'/1ay not be immediately available for reVICW, Anew <br /> PP may be sun I i2ted when tl7c file s available, <br /> 't- Any file not returned in t�c same condition as released wall be reorganized by EHD staff at the expense <br /> of the applicant Future file MViMS by the Same applir$nt may requilo a$6740 deposit prior t6 review. <br /> $• 'TENTATIVE appointment dates must be confirmed with EHD staff <br /> 6 APplicaZOns receive. af(er 3:00 pm will be processed the next bUslneS9 day. <br /> t <br /> y <br /> PONFIRMED APPOINTMENT DATE <br /> I TIME <br /> a <br /> ATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVMWED YES NO - <br /> n a i roe REVJI°Ytf DATE <br /> TDTAL P.61 <br />