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V .L l.L liJ 1.:_JiJI.1 J l <br /> i1-1 4-21ti N L7:3 1�,1-'ft rh'fi� � -v J v v.� u+u uw r�u�aurx <br /> waL a x¢�tivEo � <br /> SAN J-.LUIN COUNTYPUI BL`IC HEALTH S W ICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR '7 <br /> STOCKTON CA 93202 <br /> (209)4663420 <br /> PUBLIC RECORDS RELEASE APPLICATION A <br /> APPLICANT f C aur BUSlNESSlAGET{CY„ �t <br /> ADDRESS 3 o T /� mu f �` co C r `r <br /> PHONE FACSIMILE l9 <br /> /6 74- 9 0 6,S <br /> ppq s <br /> TENTATIVE'APPQINTMEN7 DATETIME Ir$ i3-?— <br /> (Please give 7 to dabuslnmsa days from date of appll= n submittal)''j `-U 2 2001 <br /> uvirs 3, � '- j <br /> UN <br /> BOX TO EXPEDITE RE QUEST-!R7.ee FEE-REQU _ TPROCESSEDIN3131.15INESS DAYS - <br /> SIGNATURE OFAPPLICANT DATE C9' <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY O <br /> PROGRAM ELEMENTS SEARCH _ <br /> 0 n qC 3 3 .Z20. Z ZZz <br /> ov Ur — 2 1 3 90 70z3 z zo <br /> o _ r 39 2 a zz H 80 0 80 <br /> v - `i AAR le 0' — — — -- l0/7 / o GJEZ4�6 3 <br /> p {J S _ S • 8/. So D <br /> Mad r 4P — oc f I <br /> D <br /> ENVIRONMENTAL HEALTH DIVISION FILES JUN 26 2001 <br /> Q111 .i - <br /> NDEROROULAD TANK(UST)CLEANUP SITE(LOP) ❑ 14OUSINGABATR14ENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LDP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 POG KENNEL 0 FAIRY <br /> QD HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTELMOT21. 0 PUMPER TRUCKIYARDlCHEM TOILETS <br /> ❑ TATTOO)BODY PEIRCING ❑ POOUSPA - ` ❑ LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPEGFY ABOVE) <br /> 1. List up to ten addrdsses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate boX(es). At least one file type MUST be selected. Fax to(209)4�-01;W or.mall to the <br /> address indicated above <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tan (10)days after receipt of application. The files <br /> will be held for a maximum of five badness days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked o n by EHD staff may not be Immediately available for review. A now <br /> application 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 $87.00 deposit prior to review. <br /> 6. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:0o pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> BATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NQ REVIEW DATE <br /> H' t e WO <br /> TOTPL P.01 <br />