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_11-30-2000 9E;27FV FRO TO l9t(�66104?.0 P.01 <br /> I L F;_"VCU FSO LCL Nu�u�kN <br /> \\livl SAN JflAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> � 304 EAST WE$ERAVENUE,TF11R0 FLOOR <br /> STOCKTON CA 95202 <br /> (209) 458-3420 <br /> j n BLIC RECORDS RELEASE APPLICATION <br /> IPPLICANT (1 IGT JON Q aU51NE55fAGENCY rjt LO I2 n }tr nti�i�val �yC <br /> AIDDRESS 3627 )<Clgpve- P-PA'L 5 {c 100 Qnn l2c CD 4C,/,t CA 9_5670 <br /> PHONE_q4I¢--L6I- 6c10D ex� zz,� FACSIMILEI 9l vel 3 a <br /> �I <br /> TENTATIVE*APPOINTMENT DATE Mon )Z_ /L1� Tv4E O�IFPI 5-, fm <br /> i (Please glva 7 to 10 husmesa days from date of aPPUCation subminel) <br /> V 30 ' <br /> CHECK BOX TO EXPEDITE REQUEST-$87-0�9�FEE-REQUEST PROCESSED IN]BUSINESS DAYS <br /> NO <br /> SIGNATURE OF APPLICANT �LG6rt2rt DATE J/l dao <br /> ELLE ADruiESs TWS 510E EHD STAFF USE ONLY <br /> iPROGRAM ELEMENTS SEARCH <br /> II 4N1 rA 7-.rm i.0 <br /> 2.jtib Ctwa.r�c. Wa Sivck3w+ [R f ,.. Alice - - <br /> 3; 5D`6 C r{« Wa 5{ uh CA C�nevr� S a4io 7 34'7-4 YZ2 I <br /> q 4 515CL,ov r �cT', Tf �mi,A.n i 1'Lod rl 3Sat! 22 . _... , <br /> sl 6Zo CwrEc u cA she)) {,P> 3s <br /> 6 1 4 z L',n Co1N 1;J� s }�, � Ftxa,er tkl ll.dvc,. LC t .F 3 ` 2 2 <br /> �i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> VuNDERGROUND TANK LUST)CLLANUP SITE(LOP) C' HOUSING ABATEMENT C3 SOLID WASTE LITY VEHFACICLE <br /> D OTHER CLEANUP SITE(NON-LOP) C3 FOOD FACILITY O SOLID WASTE teHICLE <br /> LE <br /> 0 UNDERGROUND TANK(moNITORINGIREMOVAL) O oOG KENNEL O DAIRY <br /> Q HAZARDOUS wASTE GENERATOR 0 CHICKEN RANCH C PKG TREATMENT PLANT <br /> TIERED PER)dITfEO FACILITY ❑ NOTEIIHOTEL O PUMPER TRUGKNARAICHEM TOILETS <br /> TATTOOlEOOY PEIRCWG ❑ pboLISPA C3LAND USE APPLICAT)ON SITES <br /> LI MEDICAL WASTE FACILITY 0 PUBLIC WATEKSYSTEM OTHER(PLEASE SPECIFYABOVE) <br /> 1.I List up to Lon addresses in the space above. Select the types} of file9 from the list above by checking <br /> I the appropriate box(es). At least one file type MUST be selected. Fax to 1209)464-0736 or mal to the <br /> �I addressindicat9d above. <br /> y, EHD wpl notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> j approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> �. A file that is actively being worked on by END staff may not be immediately available for review. A new <br /> i application may be submitted when the file is available. <br /> Q. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant, Future file reviews by the Same applicant may require a$87.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff_ <br /> (, Applications received after 3.00 pm will be proCessed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIMEC <br /> QATE CONFIRMED PHONE---- FAX INITIALS <br />