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i. AGE STFiCKTOH Wim' t <br /> 06/13!2000 14:27 209467�7'^8' UIN COUNT § III ,apo. „ ..� k �r 'A'. <br /> SAN 3bAQYPU13LIC HEALTH RVI <br /> ENVIRONMENTAL HEALTH DIVISION . JUN 13 2000 �k <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON,CA95202 NV11 L vigil 4lr\'- 1� -ALT1 '• <br /> (209)468-3420 PERMIT / SERVICES <br /> 1:11PUBLIC RECORDS RELEASE APPLICATION t <br /> y� , I <br /> IIII ' <br /> APPLICANT lfCr U BUSINESSIAGEHCY <br /> so Gc1 C�'7z3 G! <br /> ADDRESS W L9 <br /> �-y /♦� <br /> PHONE �! �/©0`� / FACSIMILE <br /> / / a~IP rJt t� !l TIME <br /> r 1\(E`APPOINTMENT DATE Lration submlttap <br /> (Please give T to 10 bu91ne55 days from date of app' ;I <br /> CHECK BOX TO EXPEDITE REQUEST-$78.00 FEE—REQUE, T)pppnROC SSED IN 3 BUSINESS DAYS Joinaoo� <br /> � DATE I <br /> SIGNATURE OF APPLICANT <br /> s .r <br /> FILE ADDRESS 11,CJ <br /> f <br /> cra to t <br /> w - <br /> 3; �ti o 1E t <br /> r � 4 <br /> LG �� 1 reg <br /> ENVIRONMENTAL HEALTH DIVISION FILES cn\\ f' Pi A <br /> ❑ HOUSING A3ATEMENT -SOLLDWAtCTE FAGILiTY IQS` <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY *❑ SOLID WASTE VEHICLE P r <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY d <br /> UNDERGROUND TANK jMONITORIHGlREMOVAL) O CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS\HASTE GENERATOR ❑ h7OTELIHOTEL ❑ PUMPER TRUCKICATION SIT TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOL/SPA ❑v LAND USE APPLICATION SITES <br /> ❑ TA7TOOIBODY PEIRCING Cl PUBLIC WATER SYSTEM K OTHER(PLEASE SPECIFY ADO1/E) 7r <br /> ❑ MEDICAL WASTE FACILITY <br /> 1• List up to tan addresses in the space above. Select the type(s) of files from the list above by checking �l <br /> the appropriate box{es}.. At least one <br /> file type MUST be selected. F x to f20A1 454-Ot38 or mail tato the <br /> address indicated above. if any EFID appointment <br /> 2. EHD wi11 n imate'f five applic 5 days b t nnollater than f lDS exist. n(10) days afterreceipt f application.iew will Thelfiles <br /> will be held for a maximum of five busineSS days For review. Appointments should be scheduled <br /> new <br /> accordingly. h <br /> 3_ A file that is actively being worked on by EHD staff may not be immediately available for roviel ii pen58 <br /> application may be submitted when the file is available. <br /> ndition 25 4 oAny f thefapplicant r Future filesr views by the samelappl e2ae co neased lt maY requill be re a 57 Y00 depos t prior tOTkOviow. <br /> ointment dates must be Confirmed with EHD staff. jk <br /> S. *TENTATIVE app (� <br /> 6 Applications received after 3:00 pm will be processed the next business day. — <br /> ii <br /> TIME <br /> E <br /> APPOINTMENT DATE �j <br /> PHONE FAX INITIALS <br /> YES NO REVIEW DATE_,.. ------yam— Ik <br /> as to I <br /> IF I <br />