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3jN.t3_;1pRR_ e_nno111 ^rrr, AGE STD'9!TON y W.a"� 4����.eC0.� �t �.t g p <br /> (x6/13/2000 14:27 209467ff' �,yy9 J 'Y"" g .d <br /> SAN SdAQUIN COUNTYPUBUC HEALTH VICES E <br /> ENVIRONMENTAL HEALTH DIVISION , JUN 13 2000 E <br /> 304 EAST WEBER AVENUE,THIRD FLOOR _N MI J \AL i ALI F <br /> STOCKTON CA 95202 <br /> .a t� (209)468-3420 PERMIT / SERVICES <br /> - pUBt_IC RECORD'S RELEASE APPLICATION <br /> APPLICANT l gl, Q BUSINESSIAGENCCYL ua / IDS <br /> — <br /> ADDRESS <br /> PHONE FACS]INILE �}/'�/� <br /> IyE•AppOINTMENT GATE <br /> /O I YIP r�lJi /1/ TIME <br /> (Please give 7 to 1a business days bom date of application submlttal)IJ ` <br /> 1/ I <br /> CHECK 6010 TO EXPEDITE REQUEST <br /> -QUEST. FEE-REQUE T ROC SED IN 3 BUSINESS DAYSDATE JV n <br /> SIGNATURE OF APPLICANT 1 <br /> IL <br /> FILE ADDRESS ��Cj <br /> Cra e <br /> No _ 1 �5t N <br /> }� w O 0. O a3`� <br /> o <br /> IF <br /> n <br /> », <br /> e� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> C3 HOUS.INGA.B.ATEMENT _ =SOL1DWAgTE FAgLTtt ' I <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) r] FOOD FACILITY SOLID WASTE VEHICLE t e <br /> r3 DAIRY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL <br /> ❑ PKG TREATMENT PLANT <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH <br /> - HAZARDOUS WASTE GENERATOR O k:OTkVHOTEL ❑ LAND <br /> TRUCKIYATION SIMT�ILETS <br /> /Cl TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ TATTOO/BOGY PEIRCING - ❑ PUBLIC WATER SYSTEM X OTHER(PLEASE SPECIFY ABOVE <br /> ❑ MEDICAL WASTE FACILITY _ 111fil <br /> q. List up to ten addresses in the space above.S elect the be selected. FI x to 20t 464 013es froM the list ab8vor mail to thag <br /> the appropriate box(es). At least One file <br /> address indicated above, <br /> 2. EHD will notify the applicant i!any EHD t olla!oles e than t n{O) days afteroreceipt f applica*on. The.files <br /> approximately <br /> five business day <br /> will be hold for a maximum of five business days for review. Appointments should be schedule <br /> accordingly. <br /> 3_ A file that is actively being worked on by EHD Staff may not be immediataiy available for review. A near <br /> application may be submitted when the file is available. ill be reorganized EHD staff at the expense <br /> re deposit prior to review. <br /> 4. Any file not returned in the same condition as released wy <br /> of the applicant. Futuro file reviDire a $78.00 <br /> ews by the same applicant may G <br /> g• <br /> *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g Applications received after 3:00 Pm will be processed the next business day. <br /> TIME <br /> CONFIRLIED APPOIN'M,ENT DATE <br /> i-ONE FAY 1":(SIAL-S <br /> DATE CONFIRMED <br /> YES NO REVIEW DATE <br /> REVIEWED --- 1 <br /> Flt JG to otcsm <br /> I <br />