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� uE[FIVY <br />SAN J QUIN COUNTYPUBLIC HEALTH $f <br />'ENVIRONMENTAL HEALTH DIVISION <br />304 FAST WGrfCR AVENUE, 7711" PLOOR <br />STOCKTON CA 95202 <br />(209) 465-3420 <br />PUBLIC RECORDS RELEASE APPLiCi <br />rl��elc; ta. n'u\,.1weu <br />l I V <br />ccl 11,! <br />TION <br />02000 <br />U4 <br />A.PPLtCART�YLh BUSINEBSIAGENCY �........ <br />t �7 5� �7 �1 _IVV!RONfviF�fl�u_ )WEALTH <br />ADDRESS <br />PHONE `' - qq FAC51hULE <br />TENTATIVE` APPOINTMENT DATE' �r� SI �v _,_ TIML IMIP�Ay 2V <br />(Phase give 7 H) 10 t)44bifWS3 days Dom cele Ofappllaatlan suZIMIU40 1 <br />0 CHUCK soXTO aXP9O1Tr. REAUr.9T-$TBAOFEE- <br />SIGNATURE OF APPLICANT <br />In 7 ausimsS DAY% <br />_ DATE `r fq Lo <br />... <br />.�/!�� <br />� • ��UI�,. �. - i��9�TilI x��'i <br />Ark <br />lam_ <br />lair.. �ar.vaa <br />• , <br />cmc 0 raW _. ;r..��11■sR����� <br />r.• iii <br />'.fl . ".� �. .u. r4 I��� <br />1�#..1� ®Tiyia/�7���111_ <br />_. <br />�. w A i. . w. -TAI � .�,1?.a.Tl7� <br />.��i�a�.R► <br />CJ 3CLJD WASrG FAr'ALrrY <br />I7 SOLID WASTE VEHICLE <br />D DAIRY <br />d PKG TREATMENT PLANT <br />n PUM1IFER TRUGWYAROICNUN TQR.=4 <br />o LAND U3! APPLICATION SUFFS <br />D OTHLR (PLEASE 6PECIFY ABOVEI <br />0 <br />T' <br />� �?i7fiNtlQllllw[!tl�LNll <br />Mimi1n11Y11f�LmlI�IIL!IL� <br />1. Litt up to tan addresses in the ep44:0 above. Select the type(S) of files from the Ilet above by checking <br />the appropriate box(es)- At least one file type MUST be Selected Fax in (7091 4tT4 l)1Ls pt mail tv the <br />addEess Indicated above. <br />z. CHD will notify the applicant If any EHD )ilea exist. An appointment for review will be confirmed <br />approximately flue business days but no later than ton (10) days after r"-Olpt of application. The files <br />will bo hold for a maximum of five businets days for review. Appointments should be schedulad <br />accordingly. <br />3. A file that Ia arUY¢ly being worked on by EHU staff may not be immediately available fOr review. A new <br />application may be submitted when the fife Ia available. <br />4, Arry III* riot retuined In the same condition as released Will be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the carne app11ca1ri may require a ST8.00 deposit prior to reVlew. <br />5 'TLNTATIVC appoinUnant dates must be Confirmed with kf'ID sunt, <br />ti. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />IN <br />TIME <br />PHONE FAX INITIAL,$ <br />REVIEW DATE <br />IU ILIL N.lu <br />Ark <br />ENVIRONMENTAL HkALTH DIVISION <br />FILES <br />rt <br />G <br />C <br />UNDERGROUNDTANK LUST) CLEANUP Slr LLAP) <br />OTHER CLEANUP SITE (NON4-CP) <br />UNULLRGKOUND TANK IMON(rVMNUA(1-MOVAL) <br />RA7ARDOU3 WASTE GENERATOR <br />TIaRQDpGRmr TGBFACWTY <br />TATTOO/30DY PEIRCING <br />MEDICAL WASTE PACILITY <br />O HOUSING ABAT!'MZNT <br />M FOOD FACILRY <br />u DOG KENNEL <br />4 CHICKEN RANCH <br />4 moTEWHOTRL <br />O POOUSPA <br />0 PUBLIC WATER SYSTEM <br />CJ 3CLJD WASrG FAr'ALrrY <br />I7 SOLID WASTE VEHICLE <br />D DAIRY <br />d PKG TREATMENT PLANT <br />n PUM1IFER TRUGWYAROICNUN TQR.=4 <br />o LAND U3! APPLICATION SUFFS <br />D OTHLR (PLEASE 6PECIFY ABOVEI <br />0 <br />T' <br />1. Litt up to tan addresses in the ep44:0 above. Select the type(S) of files from the Ilet above by checking <br />the appropriate box(es)- At least one file type MUST be Selected Fax in (7091 4tT4 l)1Ls pt mail tv the <br />addEess Indicated above. <br />z. CHD will notify the applicant If any EHD )ilea exist. An appointment for review will be confirmed <br />approximately flue business days but no later than ton (10) days after r"-Olpt of application. The files <br />will bo hold for a maximum of five businets days for review. Appointments should be schedulad <br />accordingly. <br />3. A file that Ia arUY¢ly being worked on by EHU staff may not be immediately available fOr review. A new <br />application may be submitted when the fife Ia available. <br />4, Arry III* riot retuined In the same condition as released Will be reorganized by EHD staff at the expense <br />of the applicant. Future file reviews by the carne app11ca1ri may require a ST8.00 deposit prior to reVlew. <br />5 'TLNTATIVC appoinUnant dates must be Confirmed with kf'ID sunt, <br />ti. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />IN <br />TIME <br />PHONE FAX INITIAL,$ <br />REVIEW DATE <br />IU ILIL N.lu <br />