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SAiN n,.QlJiN COUNTYPUBL3C EaL.TH I- ;VICI;S <br /> .-ENVIRONMENTAL HEAL-H DIVISI N� 11 - <br /> 304 EAST WEBER AVENUE, lRD FLOOR <br /> STOCKTON CA 95202 <br /> j203)463-,3420 <br /> PUBLIC RECORDS RELEA E APPLICATION � <br /> APPLICAN'P�L&41M 6FGC 8U51NE5SfASEHGY �' <br /> ADDRESS 83 <br /> TENTATIVE"APPOI WIME,NT DATE 71{fl1= <br /> {Please UNG T to 14 businasa days from da Of-VP11catiota subMittal) 2 2 <br /> CIdECKBOX TO5XPEO 11REQUEST X11 — QUESTPROC_ES9 0W3SUSINESSDAYS <br /> �t IH <br /> SIGNATURE OF APPLICANT DATE <br /> FI AD17 S <br /> - <br /> V 35'.28 <br /> 4 zc� Via. <br /> ✓m-t- <br /> 9• �i✓I <br /> ENVIRONMENTAL HEALTH VISION FILES <br /> UNDERGROUND TANK JUST)CLEANUP SITE(LOP) ❑ HOW51W ABATEMENT 0 SOLID WASTE FACILMY <br /> QTHEll CLEANUP SITE jNON-Lop) C1 FOOD FACILM Q SOLID WASTE V- 1CLE <br /> UNDERGROUND TANK(MONITORING1REMOVAL) ❑ DOG KENNEL ❑ DAtRY <br /> HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH ❑ PKG TREATIVIVNT PLANT <br /> ❑ TlirRF-u Peamr -Eo FAGILJTY ❑ MOTELIHOTEL E1 PUMPER TRUCKtYARDICHEM TOILE-M <br /> © TATTGOJBODY PEIRGING tl K*USPA 0 LAND USE APPLICATION SITES <br /> d hIE;DIGAL WASTE FACILITY E3 PUBLIC WATER SYSTEM 4 OTHER(PLEME SPECIFY ABOVE) <br /> 'l. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es). At[east one file type MUST b salectod. Fax#o (209)464-0138 or ttllil_ty tb@ <br /> gogress indicated aboYe. <br /> 2_ EMD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> 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 clays for review. AppotntmantS Should be scheduled <br /> accordingly, <br /> 3. A file that is actively bring worked on by EHD staff oma not be immediately available for review. A new <br /> application May be submlttad when the file is availabl <br /> 4. Any file not.returned in the same condition as release will be rent g"ketl by EHD staff at the expense <br /> of the applicant J'uture'fge reviews by the same appli nt may require a$78.00 deposit prior to review. <br /> S. 'rrF-NTATIVE appointment dates must be confirmed wi EH13 staff. <br /> b. Applications received after 3:00 pro will be processed he next business day <br /> COWPIRMIED APPOINTMENT DATE nm <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> R> IEWED YES NO RE PEW DATE <br /> B1 as 14 4IMS.0u <br />