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V 0AIb Rixa ,; <br /> V�o �;.i_ e�.j,t::sl.t I_, P�, <br /> SAN Ji&UIN COUNTYPUBLIC HEALTH SEF�ES L )� <br /> VIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR JAN 0 2 2001 <br /> STOCKTON CA 95202 <br /> (209) 468-3420 NVIRUN ✓LENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERMIT!SERVICES <br /> APPLICANT Y .JCi� S ,(�`„ _EIU31NESSIAGENCY �Y�ViYC �C\G1�(,��SnCj�aes <br /> ADDRESS -]CC �U't\tI\J '(Si Ate„✓�-yen.,. 1 ' L/r(�.m�.yn\ C A ISS �S _.. <br /> PHONE S _pi�j_(-( FACSIMILE_- -` � ���-r "-[d�1.. • <br /> ter • <br /> TENTATIVE"APPOINTMENT DATESar"-. ( TIME 9:340 ArA <br /> (Plnaao girt 7 to 10 businoss da s from date of application^.u6mitW1) <br /> -2 120911 <br /> CHECK BOX TO EXPEDITE REQUEST-//$87..00 FEE- <br /> REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT U �[ p7 — DA-tE <br /> FILE ADDRESS _T-� THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> JAN -4 2001 ENVIRONNI .- <br /> UNDERGROUND TANK(USTJ CLEANUP SITE(LOP) C � c <br /> ❑ OTHER CLEANUP SITE(NON-LOP) C }� <br /> t�UNDERGROUND TANK(MONITORINGfREMOVAL) [ • ,� �,/ <br /> ❑ HAZARDOUS WASTE GENERATOR <br /> ❑ TIERED PERMITTED FACILITY <br /> 0 TATTOO/BODYPEIRCING <br /> ❑ MEDICAL WASTE FACILITY f <br /> 1. List up to ten addresses In the space <br /> the a - <br /> ppropriate box es . At leas[one y <br /> address Indicated a ave. <br /> 2. EHD will notify the applicant If any E <br /> approximately five business days bu <br /> will be held fora maximum of five hl. <br /> accordingly. <br /> 3. A file that is actively being worked o. <br /> application may be submitted when <br /> 4. Any file not returned in the same cor :'` <br /> of the applicant. Future file reviows <br /> S. "TENTATIVE appointment dates mos <br /> 6. Applications received after 3:00 pm <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED <br /> REVIEWED YES NO t. .. <br /> EN oo 14 Qarmo "'-- <br />