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v..la nc�Sirp7 EnU lou:��L�1fGx <br /> :5AN JOAC 'V COUNTYPLiSUC HEALTH SERVICE <br /> AM- n 7 Z003 EN ...<GNMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVeNUl-,THIRD FLOOR <br /> "11%ifi.-.'f\i`J�.Iv I i:CEiLI II STOCKTON CA 95202 <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> KPPLICaNT •J���� l� I"�Il ,� BUSltvl;=AGENCY G'rO�tna Z4-"(o /i N,;A4 <br /> A[i[:R)r5S LA <br /> TENTATlV1=APP,DINTI,IEJ%T DATE `� (� 3 nMz OTD a <br /> (PIo^.:.W,ai•iv 7 to 17 bva neaa day�ate of appl:cation submihal) <br /> Ll CHECK BOX TCIE(c'e lalcE 1Eq:lEs't^.$ra.c�F(c.-FOrCUEBT?ROGEI.ScD IN 3 t3U&1NESS DAYS 2 /��.(� <br /> SIGNATURE-CFAPPLICA11T 't:,,j'��{".�J�•--Q _l DATE <br /> Fl:fi RCOF2`~S$ <br /> TXLS SIDE EHO STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> V Lt—l:)-o rc,CAa_ i <br /> Al <br /> D <br /> \o 2200 <br /> 1 <br /> III V 111)11 1;3 lill <br /> I._ �.,._..T...._._. <br /> JUL 1 <br /> ENVIRONMENTAL HEALTH DiYlSION F;LES 2003 <br /> UNDEtGAOUND'FANK ft,'311 :LEANUP$I E(LOP) M HOUSING AEATE:SENT C1 SG'L:0 WASTE FACILITY <br /> ! OTHEA C1: kNUP Sl'r;q,101i._OP) C FOOD PACILrfY G $OL1D WASTE VEHICLE <br /> UNUZAI5ROUND TANK iNONI IpRltaGdk;-M0VAL) C 003 KFNNEI. ❑ DAIRY <br /> HAZARDOUS WA-M:IILvEA.%7OR G CHICKEN RANCH 0 PK3 TREATMEriT PLANT <br /> �C. I iERSD FERhUTTED'��C:u; c ntdral_�toTaL C PUMPG R TRUCKJYARDICKEM TGILETS <br /> TATTGO.'SDDY PEIRCING G PooL 5PA M LAND USE APPLICATION SITES <br /> MEDICAL 1YASTE FACILITY PV13LIC NATER SYSTEM' C: OTHr-R(PLEASE SPECIFY ABOVE) <br /> 1. :ist up to t,-:.,n adc ress.s In the space above. Select tle type(s)of f"Ies from the list above by Checking <br /> the approp-iare I.,;X(e;;)_ A:I� .ast one fila type MUST be 5eiected. Fax:0 1091 138 or mail to the <br /> ;2�dres!I rlicatec.abvi.. <br /> 2. EHO wia noF& ttlE apilh;ant If any EHD n:es exist. Ai appoi,tment for review will be Ccnfirmad <br /> approxinsret.1 fwz!buainass days but nc later than tern(10)days after receipt of application. The,rlies <br /> will be held for a 17a;dmum of five b stress days for raview. Appointments should be scheduled <br /> ac:cordingl;. <br /> 3. A file chat ir> being worked on by 2140 staff may not be immediately avaiiable for review. A new <br /> application may 1:0 submitted when the file 1s availabia. <br /> A. Any file nct r4:turned in the Same condition as released will be reorganized by EHD Staff at the expense <br /> Of the applicant. ;suture file reviews by thO same applicant may require a$78.00 deposit prior to review. <br /> 5. *TENTATIVE appuin:nr,ent dates must be confirmed with EHA staff. <br /> 8. Applications reeaivod after 3:00 pm will be processec:the next business day. <br /> Fco7p, IRMED APPOINTMENT DATE � TIf11F <br /> IDATE CON"-IRME-0 �_ PHONE FAX INMALS <br /> REWIEWED IM; NO RirVIE-vi DATE <br /> TOTRI, P.01 <br /> T.J WUSO:60 £E90Z Luh 'i nt £886 828 60E? : 'ON BNOHd s t sFi j Dud ouaZ punoaq WONj <br />