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t�U &: Tti`f CutDuR [ARTd TE�hN L06! .9 TEF ..... ..-. APR 2 3 2001 IH SAN JO.UIN COUNTYPUBLIC HEALTH S ICES VIRONMENTAL HEALTH DIVISIO 304 EAST WEBER AVENUE, THIRD FLOOR STOCKTON CA 85202 (209) 4683420 PUBLIC RECORDS RELEASE APPLICATION I XU Y ,.,V LUG NUMnts(' /) o APPLICANT 11 p0.,, �� BUSINESSIAGENCY .p dcx faa)3 ,F�!�0 ADDRESS IZ V i� e.T,ltG��1Z U `t �1 .�.— "t 4t--'� PHONE 62i-� l._lJ�� FACSIMILE _'a4 "'0152�6 • TENTATIVE* APPOINTMENT DATE TIME remice �-7 (Piaasa give Ito 10 business days from date of application submittal) A IJ CHECK BOX TO EXPEDITE REQUEST - $87.00 FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT t (1r1_�1A?1 SAAnf�l��! DATE a=;4-61 SINOERGROUND TA f7 THER CLEANUP T O Y OF ,fF557 ENVIRONME T J I E /ra %✓7"�,Nrw", � S��ZIo Iwy(,JI I'LL CLEANUP STYE (lOP)U51NGT$STEMENT �OI.ID WASTE F .LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHiC NDERGROVNDJF NK(MON (TORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY �Zd HAZARDOUS YVE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT APR 27 nnnl Cl TIERED PERMITFACILITY ❑ MOTELIHOTEL O PUMPER TRUCKIYARDICHEM TOILETS ❑ TATLOOIBODY CING ❑ POOLISPA-P-LANO USE APPLICATION SffES ❑ MEDICAL WAST C❑ PUBLJC WATER SYSTEM LJ OTHER (PLEASE SPECIFY ABOVE) �3G3� 1 22 z`F 1. List up to ten ad&l sses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected_ Fax to (209) 464-0138 or mail to the address indicated above. 2. EMD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application_ The files will be held for a maximum of five business days for review, Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4_ Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $87.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED REVIEWED YES NO PHONE FAX INITIALS REVIEW nATF WIJAMMANk i 1 A N WAS�� SINOERGROUND TA f7 THER CLEANUP T O Y OF ,fF557 ENVIRONME T J I E /ra %✓7"�,Nrw", � S��ZIo Iwy(,JI I'LL CLEANUP STYE (lOP)U51NGT$STEMENT �OI.ID WASTE F .LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHiC NDERGROVNDJF NK(MON (TORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY �Zd HAZARDOUS YVE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT APR 27 nnnl Cl TIERED PERMITFACILITY ❑ MOTELIHOTEL O PUMPER TRUCKIYARDICHEM TOILETS ❑ TATLOOIBODY CING ❑ POOLISPA-P-LANO USE APPLICATION SffES ❑ MEDICAL WAST C❑ PUBLJC WATER SYSTEM LJ OTHER (PLEASE SPECIFY ABOVE) �3G3� 1 22 z`F 1. List up to ten ad&l sses in the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected_ Fax to (209) 464-0138 or mail to the address indicated above. 2. EMD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application_ The files will be held for a maximum of five business days for review, Appointments should be scheduled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4_ Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant Future file reviews by the same applicant may require a $87.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED REVIEWED YES NO PHONE FAX INITIALS REVIEW nATF