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J lJ a 1 : .i U l7 _ <br /> i xTO I14154ri 55661 P,t7 <br /> F R( uw las;f4uNo4N <br /> SAKI JOAQUIN COfiNTYPUBLIC HEALTH SERVICES ' <br /> ENVIRONMENTAL HEALTH ❑Iwi5i0N <br /> 304 EAST WEBER AVENUE,TF I[RU F Adis <br /> rl STOCKTON CA 95202 <br /> (249)468-3.420 <br /> .< PUBLIC RECORDS RELEASE-. APPLICATION <br /> L4(f +d-ll -BIJSINES5IAGENGY <br /> RES <br /> 5 —,57&,F i <br /> PFiOHJw FACSLhrtLE I } b6 <br /> I C-0f ] <br /> TENTATIVE;'APPOMTMFINTDATE ­3 TIME — <br /> iplta7w give 77[a lQ business days from 444e o;appGCAUQo su bion$) <br /> I <br /> CHEGi4$ti?X TO laXPEAITE.REQUEST•W D FEE-REQ ST R GESSED 7SINESS DAYS <br /> SIGNATURE OF APPLICANT DAT£ <br /> FILE ADRRESS THIS SIDE EHA STAFF tis£ONLY <br /> J I PROGRAM ELVArENT5 SEARCHPi rj <br /> JI <br /> ZNVIROls MENTAL_HEALTH DIVISION FIRES <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) ED HOUSING ABATEMENT 0 SOLED WASTE FACILITY <br /> 0 FOOD FACILITY 0 sQuD WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(NON•LOP) 173 DAIRY c "v <br /> 0 UNDERGROUND TANK(MONtTORJNCWRt_N1DVAL) 0 COG KENNEL 13 CHICKEN RANCH M PRG TREATMENT PLANT <br /> 0 HAZARDOUS wAs'rE GENERATOR <br /> Q TIERED PERULTTED FACILITY 0 MOTEIA40TEL 0 PUMPER TRVCKfYAFkWCHF_MTpILETS <br /> ❑ TATT004BODY PFIRC)NG C) POOt1SPA 0 LAND USE APPLIGRTION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTP A 0 OTHER(PI<FA$E SPECIFY AA0vE) <br /> 9. List up to ten addresses in the space above. Select the type(s)of tiles from the list above by checking <br /> the appropriate bDx(es). At leastone file type MUST be selected. Fax to[209L464-0138 or mail to the <br /> dicaW above. <br /> 2. EHD will notify the uppUcant it any EKD tiles exist_ An appointment for rOVIeW will be confirmed <br /> appr6mmately five business days but no later than torr(901 days after teceipt of application. The files <br /> will be held fnr a maximum of five bLtsInGzs days fur revivii. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that ie aciivety being worKed on by Etta staff may not be immediately available for review. A new <br /> application may be suDmitted when the file is available. <br /> a. Any file not returned in the edmc condition as released will be reorganized by EMD staff at the expense <br /> of the applicant. Futilre file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. `TENTATIVE appointment dates must be confirmed with EMO staff. <br /> 6. Applications received after 3:00 pm will be processed the .text business day_ <br /> I <br /> CONFIRMED APPOINTMENT DATE � ._ "TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVI>=!LVED YES No REVIEW DATE <br /> EH 00 lI ppl07lOY --~' <br /> TOTAL P,02 <br />