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05/08/2003 13:50_FAX. 0002 <br /> n��j RECWBD <br /> SAN JO...,XIN COUNTYPUBLIC HEALTH F '.VICES <br /> ENVIRONMENTAL HEALTH DIVISI ' <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> MY 0 8 LU0 STOCKTON CA 96202 I <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLIC:A►Tlta[�1 <br /> � 1 _\ i/ VI BUSiNES:JAGENCYZ14-14- <br /> APPLICANT N\lLhl.lh�-�QXY�A ro _ ' _ l M� k• G)y�G.'� L`T e '�1 <br /> ADDRESS � ` v <br /> PHONE ; <br /> q`(i �p_3p FACSIMILE � 14, b3? <br /> n <br /> Imo, TIME <br /> TENTATWE'APPOINTMENT DATE u" " <br /> (please glve 7 to 10 business clays from date of appllcaF3on submittal) <br /> a <br /> E REQUEST-$78.00 FEZ(,F JOCESSED IN 3 BUSINESS I AY. ' -3 <br /> CHECK BOX TO EXPEDITE �/ff U3 3 <br /> DATESIGNATURE OF APPLICANT <br /> Fill±ADDRESS THiS SIDE E•1D:>TA�FF USE GN LY <br /> PRUGP.AWk'-LEMENTS SEARCH <br /> 2 <br /> G •S l a <br /> u�lr as o�v N • - <br /> D i rran l.Lt,w� , Lord CA-- <br /> ENVIRONMENTAL <br /> A ENVIRONMENTAL HEALTH DIVISION FILLS <br /> NG A13TY <br /> l7 ::iOLI1)WAST[FACILrry <br /> UNDERGROUND TANK(UST)CLEANUP SITIn HOUSI <br /> E(LOP) C3FOOD NG A13ILICY (a sOLU)WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 11 DAIRY <br /> 0%NDERGROUND TANK(MONITORINGtREMOVAL) Q Doo <br /> o KENNEL EN RANCH 17 RKG rREATMEPIT PU\NT <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEH RANTEL 1] PUN 1'ER TRUCK/YARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACWTY ❑ pooUSPA I7 LAND USE APPUCATlON SITES <br /> ❑ TATTOOBODY PEIRCING 1D PUBLIC WATER SYSTEM 17 OTHER(PLP-ASE SPECIFf ABOVE) <br /> C3 MEDICAL WASTE FACILITY <br /> List up to ten addresses In the Spare above. Select the type(s) of files from the list above by clteckinf� <br /> the appropriate box(es). At least one file type MUST be selected. ice;! to 20n143 orail�o the <br /> address Indicat9d . eve. <br /> EHD will notify the applicant if any EHD files exist. An appointment for n:view Will be c:onfirine <br /> approximately five business ilater <br /> days forreview.ton view Appaintmel is should ays afte[-receipt of pbe'schedulec�files <br /> will be held for a maximum ofve business <br /> accordingly. <br /> A file that Is actively being worked on by EHD staff may not be imrnediat:ly available for review. A nc:w <br /> application may be submitted when the fife is available. <br /> w <br /> q, Any file not returned In the same condition as released will be reol•ganWid by EHD staff at the expen:;e <br /> ews by the same applicant may r9gUire a $78.00 deponit prior to reviE: . <br /> of the applicant. Future file revi <br /> 5. "TENTATIVE appointment dates must be ronfirmed With EHD Staff. , ' <br /> 6. Applications received after 3:00 pm will ba processed the next burin ess day y `y <br /> ' CONFIRMED APPOINTMENT DATE TIME — <br /> DATE CONFIRMED <br /> PHONE FAX II4IT[ALS <br /> REVIEWED YES NO REVIEW DATE*.,�^, - -- <br /> EM 00 14 6=4M TOTAL P.02 <br />