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S(dN Jt� --)UIN COUNTYPUSLIC HEALTH SEF �JES <br />ENVIRONMENTAL. H> AiiH QIVIStOT! <br />1 304 EAST WZQER AVENUE, THIRD (y/ <br />FLOOR <br />STOCKTON CA 95202 <br />(209)ass-sato <br />PIPBLIC RECORDS RELEASE ADDI I;CATION <br />APPLICANT V� -{s'�. { 6US1NES51AGENCY �}' 1r�7 1V 1 1�13n m-Q.It -(; n1 0 ^� <br />TENTATIVE* APPOINT*CNT DATE ��U "MC <br />LPlease vire 7 to t0 bwincis Wrs Tran gato of spPlrGdUon wtmattm) <br />I <br />CHECK BOX70 EXPEDITE REQUEST' UGF- - REQUEST PRLLg-C��E.SSED W 3 BUSINESS DAYS <br />SAIGNATURE OF PPLICAN U I DATE Q J <br />$lERGOUNOT <br />ANK {UST(NERUP StrE NREROUN07ANK(tIIAZARDOUS WA=GENERA <br />TIERt:A eaRMITT60 <br />FACILITY <br />O TA17MBODY P2IRCWG <br />1PCMF.UIGAL WASTE FAZUTT <br />1. List up to ten adds <br />the appropr4te bi <br />2. <br />EHD will notify the <br />WASTE FACILITY <br />approximately rive <br />o rOOD FACILITYI <br />Will be held for a rr <br />MMOVAL) <br />accordingly. <br />3. <br />A file that Is active <br />O PKe TREATMENT PLANT <br />❑ PVMPER TRUCKrYARDICNEM TOILETS <br />17 LAND USE APPLICATION SITES <br />application may be <br />4. <br />Any file not return) <br />of the applicant, F <br />5. <br />'TENTATIVEappoi <br />U. <br />AppDcations revel, <br />I MIS Slut EMU STAFF USE ONLI <br />PROGRAM ELEMENTS SEARCH <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />' SITE {LOP) <br />O HOUSING ABATEMENT.$OUD <br />WASTE FACILITY <br />o rOOD FACILITYI <br />SOLw WASTE VENtCCL- <br />MMOVAL) <br />❑ DOG KENNEL <br />In DAIRY <br />d CHICKEN RMC44 <br />�.{� 7. IDI'EUHOTEL <br />❑ POOLISPA <br />O PKe TREATMENT PLANT <br />❑ PVMPER TRUCKrYARDICNEM TOILETS <br />17 LAND USE APPLICATION SITES <br />0 PUBLIC WATER SYSTFM <br />13 OTHER(PLEASE SPECIFY ABOVE) <br />in the space above. Select the type(s) of files from the list above by checking <br />At least One file type MUST be Selected. Fax to 1209) 46"138 or mail to the <br />t if any EHD tiles exist. An appointment for review will be confirmed <br />s days but no tater than ten (10) days after receipt of application. The rites <br />of five business days for review. Appointments should be scheduled <br />being worked on by EHD staff may not be immediately available for review. A new <br />ubmitted when the file is available. <br />in the Same condition as released will be reorganized by EHD staff at the expense <br />ure file reviews by the same applicant may require a $87.00 deposit prior to review. <br />ment dates must be confirmed with EHD staffi <br />CI after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT <br />TIME <br />DATE CONFIRMED I PHONE FAX INITIALS <br />YES i No REVIEW DATE <br />TOTRL P.01 <br />