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03/04/2003 10:58 464al3E EWIRONMENTAL. F -L I PAGE 01 <br />',PAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES o�g4ocuu�,ncn <br />ENVIRONMENTAL HEALTH DIVISION <br />K 304 EAST WE13ER AVENUE, THIRD FLOOR � <br />�� ri R. �� STOCKTON CA 95202 <br />(209) 468-3420 7. <br />IPUBL1C RECORDS RELEASE APPLICATION ' � �{ <br />Fa _''Hr��Ply <br />APPLICAxQft�L- �d Cpl( BUSINtessrAGCNCyPri-L A-SSCG fLl,�715S jAZ-� <br />ADDRESS ��D� ��"r�l $ON �4-i%E � SL1/� rye �% /(%Gle�� ff�(�ffG�itiDCL C�•�1S�s�-� <br />PHONE 3.3 cl' O_ /77 FAC'SIWLIE f9 -3-5 `1-6y <br />TENTATIVE" APPOINTMENTbAT$HI M, rff 71 V-QD-3 -1ME [Z. 1 p�i�• <br />(Pieria give 7 to lb bualnass dais from date of application submitral) <br />�- z 3 <br />CHECK BOX TO D(P'EDITE REQ 7 SIi9.00 FEE-REQUESTPROGE5SE0 IN DUS111ESS DAYS <br />*SIGNATURE •F APPLICANT DATE' JW�zg 3tF: " <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND `LANK (UST) CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />FILE AIIDRrSS <br />TI -115 SIDE F1413 STA14 USE ONLY <br />PROGRAM ELEiME1,75 SEARCH <br />� FOOD FACILITY <br />O SOLID WASTE VEHICLE <br />tk UNDERGROUND TAMC (MONrrORINGJREMOVAL) <br />DOG KENNEL <br />S i <br />. HAZARDOU5 WA5T`E GENERATOR <br />O CHICKEN RANCH <br />2; 7 <br />11 TIERED PERMrSTEO FACTLITY <br />CW <br />In PUMPER TROCKNARDICHEM, tO1U7S <br />0 TATTOOISCDY FORCING <br />0 POWSPA <br />27D C N <br />Gnu <br />I3ty STdck G9-9.s�v <br />:' ✓ �'• __ <br />�- <br />GGf/ <br />aid C,CTuY� � 9S <br />c ; v A I I a <br />Za 7S" <br />$tier S CA9 <br />__ <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />UNDERGROUND `LANK (UST) CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />O SOLID WASTT. FAGIUTY <br />OTHER CLEANUP SITE (NON -LOP) <br />� FOOD FACILITY <br />O SOLID WASTE VEHICLE <br />tk UNDERGROUND TAMC (MONrrORINGJREMOVAL) <br />DOG KENNEL <br />0 DAIRY 1. <br />. HAZARDOU5 WA5T`E GENERATOR <br />O CHICKEN RANCH <br />0 PKG TREATMI NT PLANT <br />11 TIERED PERMrSTEO FACTLITY <br />O MOTEL/MOTEL <br />In PUMPER TROCKNARDICHEM, tO1U7S <br />0 TATTOOISCDY FORCING <br />0 POWSPA <br />'<LAND USE AI111LICATION 37LS <br />d MEDICAL WASTE FACILITY <br />0 OTHER (PUA.3t SPECIFY ABOVE) <br />1. List up to ton addresses in the space above. Select the type(s) or tilos from the list above by chocking <br />the appropriate box(cs). At least one file typo MUST be selected. Fax to (20914i34.0138 or mail to the <br />address indicated above. <br />2 EHD will notify the applicant if any EHD tiles exist, An appointment for roview %til) be confirmed <br />approximately five business days but no later than ton -(10) days after receipt of application. The fil,3s <br />will be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that1s actively being workod on by EHD staff may not be Immediatr_ly avaiiable for revicvr. A nvw <br />alpplicatfon may bo submitted when the fila is available. <br />d. Any file not ccturnod in the same condition ax reloned will bit reorganized by EHD Starr at the expense <br />of the applicant- Future rile reviews by the same appllcant may require a $89.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be Confirmed with EHD staff. �� <br />G. Applications ruceiveo atter 3:00 pre WiiT be processed the next business slay, � <br />CONFIRM Fb ,4PPQINTMENT DarIE. _ TIME <br />DATE CONFIRMED . PHONE FAX <br />REVIEWED YES NO <br />REVIEW DATE <br />INITIALS <br />I- . <br />