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SAN J+ UIN COUNTYPuBLic HEALTH SI&ICF-S �xowcwuaeFx fy�J <br /> IRONMENTAL HEALTH DIVISIO ���[ <br /> 304 EAST WEBER AVENUE.THIRD FLOOR <br /> STOCKTON CA 95202 . krR 11 20U0 <br /> (209)4M-3QO <br /> PUBLIC RECORDS RELEASE APPLICATIONvi ,,I,V --r T = <br /> APPLICANT <br /> c� •�7�}� 'BIISiNES31A(iENCY 1� <br /> ADDRESS (-5Jl�[.(./ l7! �.aC-V/'1'1�3• 7 l�"�(�j <br /> l4'-�-/ t�s[�-c_ OU" ! fir' � � �• <br /> PAC.5IMILE4%� 4'Y/- v�2/ <br /> • <br /> TENTATIVE"gpaowrMsurparE_'' Thi <br /> �i �_ <br /> (Please give 7 to 10 lklti ess days from da a of application submiCal) i 2 2000 <br /> �60X TO EXPI!DITE REQUE -S7 00 FHB-REQUEST PROCESSED IN 3 BUS1HE88 DqY$ //� <br /> SIGNATURE OF APPLICANT - I v _ DATE <br /> FILE ADOR@53 THIS SIDE EHO STAFF USE 9N L), <br /> PROGRAM ELEMENTS^LFARCH <br /> _ I L LL.N <br /> I S _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES A <br /> �NHFROROUNU TANK cusp Lop) ,w SITE(LOP) ❑ NOOSING.IUTY IdENT ❑,SOLID WASTE FACIL)TY~P� 13 2000 <br /> OTHER CLPANUP NK (NON-Lop) O 0ODo fACItL Cl $OUD WASTE VwvcLE <br /> -0-UNDERGROUND TANK ENERrFORINGJRFJgQVAL) ❑ DOG 1¢NNFl ❑ DAIRY <br /> l5TIERZD ER WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACfLI-1 Y M MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEN rotL.LTS <br /> ❑ TATTOOISODYPEIRCiNG ❑ POOL/SPA - ❑ ICA <br /> LANA USS APPl71pN 5RES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPELTFY ABOVE) <br /> f. List up to ten addre"06 in the Space above_ Select the type($)of filen from the Ilat above by eh ecking <br /> the appropriate box(es). At least one file typo MUST be selected_ Fax to f2Q91 4Ii abO.0 <br /> pddr cc )ndi Ajpd II to the <br /> z- EHD will notify the applicant if any END files wrist. An appcintment for review will be confirmed <br /> approximately five business dayG but no later than ton(10) days after receipt of applicaborL The files <br /> will be held for a maximum of five business rAays for review. Appointments should be scheduled <br /> accordingly_ <br /> 2• A file that is actively being wofkod on by EHD staff may not be Immediately available for review. A new <br /> application may be submitted when the filo is available_ <br /> 4- Any file not raturned in the same condition as released will be reorganized by ENI]staff at the expens e <br /> Of the applicant Future file reviews by the same applicant they require a j78.Q0 deposit prior bD review. <br /> `-�• "TENTATIVE appointment dates must be curfflrmed with EHD require <br /> 6. Applications received after 3!G0 pm will be procax sed the next business day. <br /> CONFIRMED APPOINTMENT DATE THAE <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> i�au r� oaru,a <br /> TGTFL P.02 <br />