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rl. . iu-17-2000 1W 2SM F _ TO 155�3�1T�12b P.O <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> E=NVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,THIRD FLOOR �J— <br /> STOCKTON CA 95282 <br /> (209)4$8-3424 <br /> , <br /> PUBLIC RECORDS RELEASE- APPLICATION <br /> APPLICANT Y1-1}11 I 1�1 e�r{O r 5 SUSINES&AGl"NGY 1 ytiJ i rt <br /> 9 ✓t el r]'rG� YAC S <br /> ADDRESS 6��!1� 4;CS✓Lb ��c_ { C {� <br /> PHONe 5 G2 out "7D.;1-1 FACSIMILE <br /> TrZNTATIVE'APPOUtTM4ENT 11ATE f — - TIMre <br /> (Flease give 7 to 10 p r3/!s.!d;Utsf dale of application 5u�miltal) <br /> CHECK BOX TO EXPJ:DITE=REQUEST-;$7.00 FEE-,lREEWE5T F ES�ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT N' � Of-{'--�"�^ DATE C <br /> Flt.E ADDRESS Ttl18 SIDE EtM STAFF USE ONLY <br /> PROGRAM ELE81EhrT-.SEARCIJ <br /> { •1'1Go t!.ii..,: v /. r {r� off- K <br /> • . � l � P c P� ; ,3Sa Mt <br /> [j W.. kc/fIC_✓r.nr� � lid; .Z9Sd 3� <br /> 500 <br /> .,i e, LeA Sx. <br /> ENVIRONMENTAL HEALTH IDIVISJON FILES <br /> UHi7ERSsROUl40 TANK(LIST)CLEANUP$!TE{LOP} C] Hdlt$ING A6ATET E XT 0 SOLID WASTE FACILfiY <br /> El OTHER CLEANUP SITE(NONd,OPi G FDOU FAC11.11Y C1 SOLID WASTE VEHICLA <br /> d UNDERGROUNfi TANK(IrmoNiToNNGIREMOVA1.) ❑ DOG KENNEL ti DAIRY <br /> G HA$ARDQUS WAS'r]:GENERATOR Q c"WKEN RANCH CI PKGy TREATMENT PLANT <br /> ❑ TIEREO Pl?4'WIT ED FACILITY 13 MOTELA10TEL fl p[MPERTRUCKIYARDICHEMTOis.IETS <br /> fl TATTOOW50PY P91RCING 0 PQOUSPA -- O LAND USE APPL]CATwN SrrEs <br /> C MEDWAL WASTE FACILITY 13 €'UBEIC WATERS'STEU ❑ ovwjut(PtF, rr SPECIFY AsovE) <br /> 1. List up to ten addresses in tho apace above. Select the WOW s)of files front III list above by checking <br /> the appropriate boxes). At least one file type MUST be selectee. Fax to 209 464.0`13§ar mail to the <br /> Addro s indlgatad above. <br /> 2. ERD will notify tha applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(70)days after receipt of appl;ration.-The files <br /> will be held for a tnaxtrnum of fiver business Maya for review. Appointments shauld be scheduled <br /> �pCprSlirig[y, <br /> 3. A file that is actively being corked an by EHD staff may not be immediately available for review. A new <br /> ilpplic$tion may be submitted when the file is avatilabl+ . <br /> 4. Any file not returned in the carne condition as released.will be reorganized by END staff at the expenw <br /> OF the applicant. F'LJ6Ure file reAgWs by the Same appl cantmay require a$87.00 dapoait prior to reviaW. <br /> 5. "TENTATIVE appointment Batas MUM be cartfirnind with EHE)staff. <br /> B. Applications received after 3:00 pm will be processed the next bUSine.S day. <br /> %-ONt-lKMb0 APPOINTMENT DATE _ , . +__ TIME <br /> 1 <br /> DATE CONFIRMED .. PHONE FAX INITIALS �^ <br /> Vi!zwEt) YES NO 1ZEVIEW DATE I <br /> CH 64 14 SWUNG <br /> l <br /> TaTAL P.02 <br />