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66- z''Lk3e7 r07:42141 FPDN U •.u.�(L.�.{.yw.=gay�i .1�•v/�� <br /> IMTE RECENGa <br /> SAN JO`XQLIIN COUNTYPUBLIC HEALTH SERVICES u IVV/ <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR JUN 2 6 2000 8 <br /> STOCKTON CA 95202 <br /> (209)468-3420 ENVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION p <br /> APPLICAN.T�`��G� }alad�� �eUf�51NF5S/AGENCY &" — <br /> I¢GORE55 &0 7�[I N � WC"J� PGu--. U'I Af i5��fx" <br /> � <br /> TENTATIVE'APPOINTMENT GATE TIME <br /> (Plca:e give 7 tv ltl busimss days from dale of application sdbmdLTl) <br /> CHECK BOX TO rXPEGRE RE SED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT AAAOAA rrffLL�~..1I��YY11 1llt DATE • - � a3 <br /> PIIS ADDRE95 THIS SIoE EHO STAFF USE ONLY �'1 <br /> I --` PROGRAM ELEMENTS SEARCH v�t ��" <br /> Iba4 T- 3 r cK�r x331 <br /> sYzI o qzo ;"z <br /> a a380 <br /> z _ d a as � a <br /> -101 Zl <br /> ENVIRONMENTAL HEALTH DiVISI DO <br /> UNDERGROUND TANK CU511 CLEANUP SITE(LOP) ❑ HOUSING AFATEMENT SOLID riASTE FAGiLtTY' _ ll�� <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY sour WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 Doe KENNEL DAIRY <br /> HAZARUO US WASTE GENERATOR O CHICKEN RANCH 0 PKGTREATMENTPLANT <br /> TIERED PERMITTED FACILITY O MOTELBMOTEL 0 PUMPER TRUCKNARDICHEM TOILETS <br /> TATTOOIBODY PEIRCING O POOUSPA -A LAND USE APPLICATION SITES <br /> L1401CAL WASTE FACILITY 11� PUBLIC WATER SYSTEM C1 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up tO ten addre�ea in th& space above. Select the type(s)of files from the list above by checking <br /> ala type MUST be selected. FFax to 1209) 4640138 or mail to the <br /> 4 G C� OGre l�O n � t✓J� J files exist. An appointment for review will be Gonfilmed <br /> U <br /> no later than ten(10) days after receipt of application. The files <br /> n j4AJ-0?Ry f/J 4{�� i�P.__ Hess days for review. Appointments should be scheduled <br /> p�C_r„ ;�A �,� Eby EHD sfaff may not be Immediately available for review. A new <br /> � a�p <br /> l71 ,4 l)S LYS p file is available, <br /> ition as released will be,reorganized by EHD staff at the expense <br /> IV�01/ the Sam@ applicant may require a$78.00 deposit prior to review. <br /> ie confirmed with EHD Staff. <br /> II be processed the next business day. <br /> _ TIME <br /> _ PHONE FAX INITIALS <br /> REVIEW DATE <br /> x,� TDTCL P_02 <br />