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r. SAN t.x.i . <br /> irm-iyr� ni•��rl� rro�rl [Moot <br /> oA'rE ric o lu 141S3.6219r <br /> 55 p_q2 � <br /> J&QUIN COUNTYPU13LIC HEALTH &VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 • <br /> (209)4683420 Welty, <br /> , <br /> PUBLIC RECORDS RELEASE APPLICATION(} LLLL <br /> g 7g <br /> APPLICANT_ fAVI..- f7i�4w}yY• BUSINESSIAGENCY GJQX2—J a3y.��f..�FN..I [ � .�f 1 {iJC• <br /> ADDRESS_ Ibiat—A } 'DQ-- '5r( 100 <br /> PHONE MIS )?,'j5 — C,-pj$q, FACSMILE__�L�/�j — •fff'�y <br /> TENTATIVeAPPOINTMENT DA-FE _ L-30- 3g TIME <br /> IPla Dlve'7 to 10 business days from date of a4ybcafion submAb[) <br /> CHECK BOX TO EXPEDRE REQUEST•$78.00 F REQUEST PROCESSED N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � � DATE <br /> FILL ADD RE S <br /> 3S ut E Qcr, b _ S <br /> v rb <br /> z0qjog-- <br /> :612v-TIA CA WC 01 �1 <br /> N o4- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING AmA7FNIFNT d SOLID WASTE FACILITY <br /> �SCOTHER CLEANUP SITE(NON-(_OP) ❑ FOOD FACILITY ❑ S011D WASTE VEHICLE <br /> UNDERGROUND TANK IMONITORWWREMOVAL) O DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE CIENER.gTOR O CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEJRCING ❑ POOLISPA CI LANp USE APPLICJIYION SI7E5 <br /> O MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses 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(2091 464-0138 or mail to the <br /> sddresslndlcated above <br /> 2. EHD will notify the applicant if any EHD files eXlst An appointment for review will be Confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the same Xpndition 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$78.00 deposit prior to rev)ew. <br /> 5. 'TENTATIVE appointment dates rn + f be confirmed w)ffi EHD staff. <br /> 6. Applications received alter 3:00 pm will be processed the next business day. <br /> IQ <br /> I� <br /> � � �2h cC CQ� � uZ1n �a/ 31 / 99 TOTAL P.02 <br />