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I � <br /> SAN J QUiN COUNTYPUSUC HEALTH ?ylGES <br /> # ENViRONMENTAL HEALTH DIVISION <br /> i 304 EAST WEBER AVENUE, YHIRD F1r0011 <br /> l STOCKTON CA 95242 <br /> (203)46$-3420 �f <br /> PUBLIC RECORDS RELEASE AP,PLICATION ' <br /> APPLICANT.A41--V/N/ C_�G�C~ _ WUSiN€SSIAGENCY f C <br /> ADDRESS S&Uej aadv 1L. ?=Y <br /> AHdNtr U FACSWILE I n{!�'I i, „i I i ';�:'r i I j <br /> TENTATIVE`APPOIWrP4FNT DATE_ ;-0?4~ <br />{ (Please U"7 to 10 besinass day3;f mm date of 1 2001 <br /> Y app!cation submittal) 1 <br /> CHFCK BOX TO Eta>;prM REQuts r- 7 . 0 I QUEST PROCESS ED IN 3 BUSTNM DAYS <br /> SIGNATURE OF APPLICANT DATE P`>= <br /> i` <br /> �'I AD17 s� <br /> i <br /> - <br /> s' � <br /> V t �S2Cv LD. <br /> i, <br /> a g. i M L <br /> Std `4 3 S2 <br /> ENVIRONMENTAL HEALTI-I DIVISION FILES <br /> UNACRGROUND TANK(UST)C4F-AI4UP SITE(LOP) ❑ HOUZiING ABATEMENT0 S0I.113 WASIM FACILirY <br /> . arHER CLEANUP SITP K101){NON-LOP) ❑ F17 FACILITY ,I Q SOLID WASTE VrJ 01-E <br /> UNDERGROUND TANK 4rA0N1-r0R1KGIREMOYAQ 0 000 KENNET. ❑ DAIRY <br /> NAZARDOUS WASTE GEN9RATOR 0 CHICKEN RANCH Cl 1PKG TREATMENT PLANT <br /> ❑ TIERED PFRUF TED FACILITY ❑ TMCrrE OTEL Q PumPER TRUCKIYARDICHEM MILE7''S <br /> D TATtO4l5ODY PEiRCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MUICAL WASTE FACII_1TY C1 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> �.p <br /> List up to ten addresses in the space above. Select the type(s)!of files from the list above by checking I <br /> Ih the appropriate box(es). At least one file type MUST bre sell ctod. Fax to 209 4154-a'1311 or mA It <br /> a adcress'indicalted above, <br /> 2_ EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five busin$$s days but no later than ten (10) days,after receipt of application. The files <br /> will be held for a maximum of five business clays for review. A'pointmants should be scheduled <br /> accordingly, <br /> 3. A file that is activta(y being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the filo is available. I1 <br /> 4. Any file not returned in the same condition as released will he reorganlzed by EHD staff at the expense <br /> of the applicant. Future'file reviews by the same applicant may',require a$7&00 deposit prior to review. <br /> 5. *TENTATIVE appointment elates must he confirmed with EHD staff. <br /> 6, Applications received after 3,00 pm will be processed the next business daly- <br /> ' I� <br /> C014MMED APPOINTMENT DATE TIME <br /> DATE= CONFIRMED T � PHONE Fm INITIALS <br /> l <br /> REVIEWED YES NO REVIEW DATE <br /> @i QO '!f dlro.M <br />