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v <br /> -�I2ECSIY1: numtlCN <br /> I � SAN JOQUIN COUNTYPUBL[C HEALTH SLICES \LIQ LVA <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> 304 EAST WItOMR AVLNUt:I THIRD FLOOR <br /> CCC STOCKTON CA 95202 l tj <br /> (200)408-5420 , <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPMANT-4m �7ykk k 9USINRWAGENCY_____-- ..... { 42000 <br /> ADURES31�I.� 1�Y'� 9] 0 -NVIRONMF�il-,�i- <br /> _ t FALTH <br /> �p ' LzZ �4IP - I <br /> / F ;VICES <br /> PHONE IZ�� �`^tlD EE-D4�y FACSIMILE <br /> TENTATIVE`APPOINTMENT DATL � r�fil ob TIME I I CIC) pm <br /> (P)Lase Qive T 010 business days from dare W appIIWIQn submltta() I <br /> Lj <br /> CHBCK SOX TO axPa01T6 RcgU64T-{7a.QU FEE-AGQ P ESSED IN a BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 1 i(X <br /> PILE DRESS THIS SIDE END STAfF USE ONLY <br /> ( PROORAfa VIPMf NY$SEARCH <br /> no Y, <br /> cI <br /> TU <br /> ENVIRONMENTAL HEALTH DIVISION FILES WK 21 LU <br /> UNDERGROUND TANK(UST)CLEANUP SIVE(LOP) O HOUSING ABATEN4NT O 8OUD WAStE FAGILrfl' O <br /> OTHER CLEANUP SITE(HON.LWI M FOOD FACILrtY O BOUD WASTE VEHICLE I� <br /> UNOLLRGKOUNU TANK(MONROMNUIRLW04AL) U DOG KENNEL 0 DAIRY T' <br /> HAZARDOUS WASTE GENERATOR C1 cKLCKEN RANCH 0 PKG TREATMENT PLANT <br /> P1 11aR90 PGRMn-MD PACUITY , O mOTI4NOTRL O PUMPER TRLCWYAROICKM TOR.CTe <br /> ❑ TATT00130DY PEIRCING O POOVSPA O LAND uaE APPLICATION SITES <br /> ❑ MEDLCAL WASTE FACIL.PrY ❑ PUBLIC WATER SYSTEM Cl OTHER(PLEASE SPEGIFY ABOVEI <br /> 1. List up to tan addresses in the Space above. Select the types)of filer,from the list above by checking <br /> the appropriate box(es). At least one Tile type MUST be selectBiL Pax to [2081 4tS4-0 8 Or mail to the <br /> add!{i5s indicated above, <br /> 2. SHO will notify the applicarn If any ZHU Was exist, An appointment for review will be confirmed <br /> approximately five business days but no later than ton(10)days after racelpt of application. The files <br /> wNl bo hold for a maximum of ftvc business Clays for review. Appointments should be aehedulod <br /> accordingly. <br /> 3. A file that Is aCffftly being worked on by EHE staff may not be immediately available for review. Anew <br /> application may be submitted when the file Is available. <br /> 4, Any Ne riot rmtumed In the Same oonditian as released wEl be reor®anlZsd by EHD staff at the expense <br /> of the applicant. Future Me reviews by the same applicant may require a$78.00 depaatt prior to review. <br /> S. `TENTATiVC uppwintment dates must be odnflrmod with EftV staff. <br /> 6. Applications received after 3:00 pm will be processed the next businoss day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> -VW-14 FZW <br /> wlc� I'.Lu <br />