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D SAN J(" '.)UIN COUNTYPUBLIC HEALTH SF-VICES <br /> �. JVIRONMENTAL HEALTH DIVISIOnr <br /> S f r, q (t 7OQQ 304 EAST WEBER AVENUE,THIRD FLOOR 1"4 " i <br /> STOCKTON 95202 <br /> I [. (209) 468-3-3 42D <br /> I &TH <br /> PUBL_IC_R., EGORDS RELEASE APPLICATION <br /> APPLICANT LoL BUSINESSIAGENCYQJJaAct,V (,W0 u <br /> m0,0,)Me1) <br /> ADDRESS OJ- / 1• <br /> 11/ S Q C ^� �CCASa0,S- <br /> PHONE -IOD FACSIMILE <br /> APPOINTMENT DATE 1A TIME k O <br /> (Phase give 7 to 10 business OVs from date of application submittal) <br /> X`•tTEXP ITE°R�ErQ(IESY° 8.00 EEE-rf EQUESTPROCESSED.IN I BUSINESS DAYS., (, , <br /> SIGNATURE OF APPLICANT ) 2II DATE v r -14-2000-200 0 �e <br /> FILE ADDRESS 6_ <br /> CJ S Ce(>Z > 5T>267 IdCl <br /> C�C}ts�l <br /> ENVI11tONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENT ❑ SOU13 WASTE FACILITY <br /> OTHER <br /> CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOCLSODYPEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I. List up to ten addresses In the space above. Select the type(r)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091 464-0136 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the appllcant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application. The files <br /> will be held 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 /> appllcatfon 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 the same applicant may require a $78.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. 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 <br /> Ek 06 14 Et/CL40 <br />