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JAN-21-03 10:41 AM OXOXOXOXO 559 325 2297 P.01 <br /> 01121/2003 00:53 4640131 El r4IPtY(MENTAL HEAL PAGE 01 <br /> SAN JOAQUIN COUNTYPUBIJC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FL09R ` <br /> JANSTOCKTON CA 95202 <br /> X 2003 (209)468-3420 <br /> ��..i PUBLIC RECORDS RELEASE APPLICATION <br /> /APPl.1GA V i,'I '(a O 5 <br /> 77 f DUSrNESSIAGENCY <br /> ADDRESS— Cx �,� .. 1rCS Y)_L +Y-,c G <br /> PHON U 1 33 I�t FAGIs1Mn r <br /> TENTA7IVE'APPOINTMCNTUA7E• , 1 LR� -o-3-- <br /> TIME .,,/ � �•. <br /> (Ploaae elrn 7 In 1n husiness dup from date of pplfeallen subntl(tal) ` <br /> ❑ �HE+:K tiSlX T17 rxYrnit>=ernl la IT,, 60.00 FG4 RCQ�U jLC/�Prl=DOE D 1115 OUSIlIESS 1511Y3 <br /> '51GNATURE OF APPLICANT " �- _ DATE <br /> • mow':' <br /> !ILL AOtJRE55 rJ18 SIDE END STAFO Usti ONLY <br /> PROGItAnt ELEMENTS.511MC14 <br /> ip, VI t t. ti r e.tn <br /> IT Ouu,cLits QUA` >< <br /> 3, <br /> Sia o - � c•_ .c lett . b <br /> ILA <br /> c f i G <br /> cL V 17 1 <br /> E;NVI%0NMNTAL H D�W(510N FILES ' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) OUSING ABATCNIFNT SCUD WHITE FACILITY ' <br /> OTNER CL <br /> CANVP SITE(NON-LOP) FOOD FACILITY D bOUD WASTE 1fEHICLL <br /> NI � G/tEMOVAL) CH�KENNEL O DAIRY <br /> 0 K[N RANCH 1�PKG TREATMENT PLANT <br /> FAZAbOUSWA57E GLNERATOR ❑ MOTKIOTCa PUMI toTnUolWAhV/OIMM Y0ILCTp <br /> TI D RrY <br /> +. <br /> ITTUD D TA7TO0/OpbY PEIACINO O POOUSPA O OTHER <br /> (P A>'P1.1CAT10N SITES <br /> f] MEDICAL WASTE FACILITY OTHER(PLEAS:St►ECIsY AOOVL) <br /> A ste esta <br /> i. List up to ton addresses In the space above. Select the typos?of files from lho teat above by choakt�' r . <br /> tho oppropriatc box(es). At least ono rile type MUST be sclocted. Fax to(209)454-0138 or mi 1 0 <br /> address Indic�ata4 abov(%. <br /> 2, EHD will notify the applicant if any END files exist. An appointment for review will be confirmed <br /> approximately five buslness days but no lator than ton(10)days after rvcolpt of appllextlon. Tho <br /> will be held for a maxlmt)m of five business days for review. Appointments should bo scheduled <br /> accordingly. <br /> 3. A file that Is,actively being.ae(kod on by END Staff may not be immediately availauta for revlow, <br /> application may be submitted when thn fila is avallablo. <br /> 4. Any fila not roturnod in the name condition as relcegcd will be reorpanIted by EHD staff At the vA0n ,..,.,. <br /> of the applicant. Future filo roviewb l,y thu soma 4oppl►Cant may require a$69.00 doposit prior to revi <br /> 5. 'TENTATIVE appointment dates must be coniirmod with I=HO staff. <br /> G. 'Applications rccC)ved after 3:00 pm will be prvcossed the nUxt business da <br /> CONFIRMED APPOINTMENT DATE. ___ TIME .�— <br /> DAYF CONPIRmE0 ___ _ PHONE FAX INITIALSop <br /> �•,__„_,,,,�, , <br /> REVIEWED YES NO REVIE=W DATE <br />