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Mar 23 04 06: 42p `c �upational knowledge _ p. 2 <br /> SAN�AQUIN COUNT"PUBLIC HEALTH SERVTi:CS <br /> %• `V/ � Y CNVIRONMEN AL HEALTH DIVISION <br /> Iv �J <br /> L—_ 704 EAST WEBER AVENVE,THIRD FLOOR I <br /> STOCKTON CA 95202 <br /> MAR 2 3 2004 (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �(^PSI�ICia/pl �Tf GO ._... <br /> _oOUSINESSIAc:((E��NCT n�Ct//D [M� r'l O�C+ W -` <br /> ADUnIa <br /> TGNYgiIVE'npPOrNTM[N10nTE (� m; Vl( TIME 6 <br /> (Pleaaa eFo T to la OVvtnau UalT Irem J.+lo of npPlicallan 5uam111^11 � <br /> C] CHECK OOx TG CAPEDITE RCOV@Sr•$09.00 rEC ESTPROCESS ED IN 7 DUSINC55 OATS , <br /> h SIUNAT URE Of LPPLIGANT DATE <br /> PILE ^009ESS THISE ENO STAFF USF ONLY <br /> PRO R M ELEMENTS SCAn CK <br /> Ski <br /> �1 ENVIRONMENTAL HEALTH DIVISION FILES <br /> •1G1 VNUL110110'JHO TANK tUSTICLEANUP 511C(LUPI 0 NUU$NC AOA I CME HT 0 SOLID WASTE FACILir, <br /> �C UInCN LLLA.NVV S11t 01000 rACILIYT 5000 wA5YL VGuCII <br /> 1C UH0t FCAOUND TANK(MONITORINQMEMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ..r,' IIAL n9 DOVs WASTE GENERATOR O CIDCKCN RANCH 0 PKC TREATMENT PLANT <br /> U 11€nEO PfAMITTrp FACILITY O MOTEUHOTEL 0 PUMPER T APPi tCAnION SIT TOILETS o <br /> n Tnl TOOleaov r•LIACt"O O PCOUSPA n LANs USC APPI KATION SITES ? <br /> �0 MCOICAL WASTC rACILITY - 0 OI UER IPlGnS[SPCCIfY AOOVEIy <br /> I <br /> Y. List up to ton addraSses In the space above. Salael the typo(s) of lila: from the list above by checking <br /> the approprlalc bo:(os). Al least one fila type MUST be eelected, Fax t0 (709) 464.0170 or mail to the <br /> addre5s Indicated above <br /> 2. EHD will notify the applicant It any EHD files exist. An appointment fo( review will be Confirmed <br /> approxim.1tnly live business days but no 13tor than ton(10) days after receipt Of appliCalior. The files _ <br /> will be held for a maxlmurll of live business days for review. Appointments should be schedulao <br /> accornin0ly. <br /> 7 A IJa that Ix Icl.valy bcln0 worked on by EHO staff Indy not be Immodlately Available for review, A now j <br /> a ppliu tbn may Ue SUa,niUad when tho (Ila is avallable. <br /> Any life not returned in the same condillou as reloesed will be reor0anttod by END staff at (he expense <br /> of lho opplle3nL Future file reviews by the same applicant may ropvire a 100.00 deposit prior to reYttw. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> y. Applications received after 9:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE __._ TIME <br /> 1 <br /> OATS CONFIRMED PHONL FAX INITIALS <br /> RGVtCW120 YES NO REVIEW DATE <br /> I <br /> i <br /> I <br />