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(iLGEIVLU - U �' � <br /> SAN AQUIN COUNTYPUBLIC HEALTHORVICES -. <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 RECEIVED <br /> (209) 468-3420 JNN 13 2000 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �EJ'� BUSINESSfAGENCY CIO>; <br /> ADDRESS She 31 /Z <br /> PHONE 1925 x!62 —6990 FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> ' (Please give 7 to 10 business days from date of application submittal) ._QW <br /> 13 CHECK BOX TO EXPEDITE REQUESST/TJJ-$78.OR FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /f L /lir. G' �'f" SKy�s DATE �3 rBv <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 4ot N. ST cK.rbm ex. <br /> 1 <br /> l a � <br /> 4mis j2ge4. <br /> I \ _ ' /tri <br /> t <br /> C�Oo1pd���D <br /> y� E q ..acs-.a j -.... ._.. _., �� <br /> RL UNDERGROUND TANK(UST)CLEANUP SID WASTE FACILITY <br /> 13OTHER CLEANUP SITE(NON-LOP) )' \�.Y ��S. .ID WASTE VEHICLE <br /> 13 UNDERGROUND TANK(MONITORINGIRE RY JUN 16 2000 <br /> C3HAZARDOUS WASTE GENERATOR Pa S't -. I Y�J) `� > i TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ID ERT APPLICATION SIM <br /> TOILETS <br /> ❑ TATTOO/BODY PEIRCING / L 1 _ �p ID USE APPLICATION SITES <br /> jER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses it om the list above by checking <br /> the appropriate box(es). P m (209) 464-0138 or mail to the <br /> address indicated above. f _ <br /> 2. EHD will notify the applica Tom, ./ S�cV� / P_OI�I -eview will be confirmed <br /> approximately five busine: ceipt of application. The files <br /> will be held for a maximun :nts should be scheduled <br /> accordingly. <br /> 3. A file that is actively being Lely available for review. A new <br /> application may be submil <br /> 4. Any file not returned in thl ;ed by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6- Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 OV24I00 <br />