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E�-17-29Q'] '-hLr1 � &--, <br />TQ <br />07:2aPPl1^k7'-:a:.ag56 P.[i1 <br />APPLICANT <br />W 0 <br />SAN JOAIQUIN COQNTYPUJ3LIC HEALTH SERVICEc <br />ENVIRONMENTAL HEALTH DIVISION <br />004 EAST W ESER AVENUE, THIRD FLOOR <br />STOCKTON GA 95292 <br />(209) 408-3420 <br />PUBLICS RECORDS RELEA$E APPLICATION <br />RUS:NESSIAGENGY CA I-" <br />3T I✓ W -C-) Vl4C4Jru <br />2p0, <br />TENTATIVE' APPO!N rMENT DI41E time <br />(Plaasa s;+e,7 to 10bvsinlas's daj: h Urn OAto of&t9licatian:ubmi;:aq MAY 18 Lii01 <br />❑ CHECK SOY.TU kXP2D13E RCQ T-Sb7.00 FEE0X EST <br />S Oe , IN 16USINESS DAYS <br />SIGNATURE OF APPLICANT _ _ DATE <br />FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND TANe, (VST) CLEANUP s(1 -r; (LOP) ❑ HOUSiNC AEATEMEN T ❑ SOLID WASTE FACILITY MAY 22 2001 <br />OTHER CLEANUP SLTE INON•LOP) 1 ❑ FOODFACILITY ❑ SOLID WASTE VEHICLE <br />. UNDERGROUND TANK (MONITORINGIREMOVAL) t7 DOG KENNEL n DAIRY <br />HAZARDOUS WASTE OEMERATOR i ❑ GHLCKRNRANCH Z3 PKG TREATMENT PLAtTT <br />TIERED PERM'ITED FACILITY ❑ MDTEIJHOTF IL 0 PUMPER TRUCKJYARWCHEM TOLLktS <br />7ATTOOFBODY PEIRCING ❑ POOL'SPA CL LAND USE APF UCA.TION SITES <br />G MEDICAL WASTE FACILI JY C1 PUBLIC'N,ATER SYBTHM G OTHER(PLEASE SPECLFY AagVE) <br />1. List up to ten addrasses in the space above. Scicct the type(s) of files from the list above by checking <br />the appropriate box(es). Ail least one file type MUST be Selected. Fax to (209) 464-0928 or mail tam <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 businass days but no later than ten (10) days after raceipt of application. The files <br />will be held for a maximum'of five buslncss days for roviaw. Appointments ahould be acliedulad <br />accordingly, <br />3. A file that is actively being worked On by EH13 staff may not be Immediately available for review. A new <br />appllcatlon may be submitted when the Hla is available, <br />4. Any file not rebunod in the came condition as rcleasad will be reorganized by CHD Staff at ilia expense <br />of the applicant. Future file review: by the same applicant may require a $47.00 4epcuif prior to review. <br />S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />E, Applications received after 23:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE OONFIRMED <br />TIME <br />PHONEFAX <br />REVIEWED YCS NO REVIEW DATE' <br />INITIALS <br />_ I <br />