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�..a _ <br /> SAN JUIN COUNTYPUBdC HEALTH SF ~ DICES <br /> VIRDNMENTAL HEALTH DIVISIOi 00/470 <br /> 304 EAST WEBER AVENUE,`THIRD FLOOR <br /> %.VOPY STOCKTON CA 95202 <br /> (209)468-342D <br /> PUBLIC RECORDS RELEASE APPLICATION _ <br /> BLiS1NE53lAGENCY t/� � �J R . <br /> APPLIGAN <br /> Ll <br /> ADDRESS <br /> PHONE <br /> �!U FACSIMILE. <br /> TENTATIVE'APPOINTMENT ELATE TIME <br /> Il TIMIE sutxrtittal] <br /> (Pl¢ase give 7 to 10 business days tram date of app t <br /> h. <br /> CHECK 80X 70 FJCF'E[1E"rE REC1U T-S78.6Q FEE—REQU1= R.00ESSED IN:I Bt1S1ElFCS$DAYS <br /> r' DATE .JI <br /> SIGNATURE OF APPLICANT <br /> FILE Af]Dril S5 )`�� S -,Nc p`�fi �4 <br /> W r <br /> It x tt <br /> 1[ It I <br /> It 11 I� <br /> 9 <br /> 4 <br /> tb' ' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> c inHOUSING <br /> SOLID WASTE VEHICLE <br /> HOUSING ABATEMENT 0 5UI_ID WASTE FACILITY <br /> ONDERCROUND TANK(UST)CLEANUP SITE(LOP) Cl FOOD NG ABY <br /> OTHER CLEANUP Styr(NON-LOP) M DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORiNGIREMOVAL) 0 Ill TREATMENT PLANT <br /> HAZARDOUS WWASTEGE0 CHICKEN NERATOR O CHICKENMOTELIHRARALNCH ❑ PUMPFR TRUCIUYARI 1CHEM TOIt.ETS <br /> FlER1rD PERMITTED FACILITY p POOUSPA M LAND USE APPLICATION SITES <br /> ATTgQQY PEiRCING <br /> C1ATT AL 1NA57> FACILITY 0 puBt lC WATER SYSTEM 3l,1-OTHER LEASE SPECIFY ABO <br /> 'Fair •Rejo <br /> Q TOtil <br /> 4n J•I <br /> 1_ List up to ten addresses in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate bax(es). At least one file type MUST be selected. Fax to 209 464-0135 or mail to the <br /> address Fridicated above. <br /> 2. EHt]will notify the applicant IT arty E14D files exist. An appointment for review will be confirmed <br /> but no later than ten j1D�days after receipt of application. TI,e hies <br /> approximately five business days <br /> will be held for a 13Maxirnum of five business days for review. Appolntmsnts should be scheduled <br /> accordingly. <br /> 3. A file that 15 actively being worked on by EHiJ Staff may not be (rnmediaieiy available for review_ A now <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by e confirmed wlittt EHdaataff ulre a $713.00 deposit prior to review. <br /> am <br /> *TENTATIVE appointment dates mus <br /> 5. pp day. <br /> d ext business y <br /> 6. Applications received after 3:00 pm will be processed the n <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Elf 09 14 01141ma <br />