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-- 99-84-20101 11 : 33W FROM 1 ❑ � � 1._-r���lit <br /> 1 ' - SAN JQAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> r irc _ <br /> ; ENVIRONMENTAL HEALTH DiVlS10N <br /> 1 304 EAST WESER AVENUE, THIRD FLOOR (IJ <br /> CFP SfOCKTON CA 95202 <br /> Chi �j FI (209) 488-3420 <br /> Ic ,.; dfc 55 PiJBL{ C RECORDS RELEASE ADPL ) CATJONr <br /> APPT` 1�1FrtU �.]km Utl- SQN. 8'USItSESS/AGENCY � �� �J`IV I�UNM TA'{- � 1r� C <br /> ADLOTS ' lir$2_ NodA Tt� �,ouu vf�fzi� SU ) re Too <br /> PHONr { tl ) 5 849 - I LD OO FACSIMILE ( 415 $ q9 1CoADI <br /> TENTATIVE' APPOINTMEi( r DATE" c�ns, • I ,,, TIME _WVI <br /> !• P7 b'' � <br /> (Ploaelu bL/.lvI. fe��`77tt/o/Jie buzI` d 's from da'w of application sUl mhtaq <br /> u III <br /> CI ECK BOX TO EXPEDITE REQUEST - $u7.09 FEE - RI!Q1jEPROCE$5£D 11,1 3 BUSINESS DAYS ' <br /> 51GN TURF OF APPLICANT DATE <br /> I ; <br /> PILE ADDA�E35 THIS SIDE ENO STAFF USE ONLY <br /> PROGRAM ELEMENTS SCAKCH <br /> 3LP1i7 SCAII- t-i AtP. Poty-T ' lt1k _ - <br /> 3;13 axi'rt-t A tf;PoKt V,�A -F , 2�/• (r0 t l7- 3S1S relL <br /> 5 SCu'm ' t2Pbl?.7 A �S• z 4 1 - --�� <br /> i 3 Sou Tri EL_ bo tpo S` C EET 35 a,(a }4(C <br /> z4�2 5eLrTtt L !# fib ST(L6E 1 ' v 1 <br /> u 1 B <br /> it <br /> - <br /> 24b <br /> :sOwmakN CAL,IL <br /> CA r <br /> Cg/TNST <br /> UNDERGROUND TANK (UST) CLEA,jvr slit: (LOP) U HOUSING ABATEMENT 50LJO WASTE FACILITY <br /> OTIIERCLEANUP 5VE (NON•LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UN ERGROUNP TANK (MONITORINGIREMOVAL) ❑ DOG KENNEL DAIRY <br /> HA�ARDOUSvl ASTI� GENERATOR ❑ CHICHCN RANCH PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELIHOTEL PUMPER TRUCKJYARDfCHEM TOILETS <br /> ❑ TA TOOJDODYPEIRCING C POOLISPA LAND USE APPLICATION Sn'ES <br /> ' Q 'MEDICAL WASTE FAcjLrrY - O PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 1 . List up to ten addresses in tho space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). '; At least an file type 'MLJST be selected_ Fax to (209) 464-0138 or mail to' the <br /> gddress indicated shove. <br /> z EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five bwwress days but no later than ten (10) days after receipt of application. 'The tiles <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worXod on by EHD staff may not ha immediately available for review. A new <br /> application may be submitted when the file is available. <br /> AV Any file not returned in the *tune condition as released will be reorganized by EHD staff At the expanse <br /> 5. Iof the applicant. Future file reviews by the same applicant m ty require a $87.00 deposit prior to review, <br /> `TENTATIVE appointment dates must be confirmed with EHD staff. <br /> ew ` Applical(ons received after 3:00 pm will be processed the next business day. <br /> co RMED APPOINTMENT DATE TIME <br /> DATEICONFiRMED • PHONE PA?C INITIALS <br /> REV! IWED YES NO REVIEW DATE j <br /> c , own TOTF)L P . 01 <br /> .a <br />