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A.,r 2001 I PM CQNUUX BhiH IE�HNULOu]Eb fl 0 <br /> -SAN J0_ JIN COUNTYPUBLIC HEALTH S1 'ICES Num&LA <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AIIJ G 2 4 2001 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT a,__<_kVt_C.LQ ' S <br /> -31 9L <br /> ADDRESS T_ <-A 952.0 (, <br /> PHONIE Z01 2_3 ns-L e, FA=MILE 9 .2-t <br /> TENTATIVE-APPOINTMENT DATE -nwE <br /> r_s!�A-CDr <br /> (Please give 7'to ass days from dale of appU=flon subrnitta� <br /> I <br /> CHECK BOX TO EXPEDITE REQUEST-$81.00 r-CE-REQU ST PRqCESSLN 5 13USINF-SZ DAYS <br /> SIGNATURE OF APPLICANT DATE 6/Z 3/6-7 <br /> FILE ADDRESS THIS SIDE F_qD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 11:5 fIn ivy o <br /> �... <br /> v�. <br /> I,1, >�. _ 0 0 <br /> t2,0(, <br /> 8so M <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> fa/uNDERGROUND TANK(UST)CLEANUP SITE(LOP) E3 HOUSING ARATEMFUT 0 SOLID WASTE FACILITY <br /> WOTHER CLEANUP SITE(NON-LOP) C7 FOOD FAGI.LITY 0 SOLID WAM vr_-HICLE <br /> W-YNDERGROUND TANK(MONITORJNGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> Lk'HA7ARCOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> El TIERED PERMITTED FACZJTY 0 MOTEUHOTEL C] FUUPF-tZ TRUMYARDX14EM TOU-EM <br /> O,XATTOCIBODY PEIRCMG 0 PCIOUSPA - - El LAND USE APPLICATION SMES <br /> 5r MEDICAL WASTE FACLUTY 171 PUBLIC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> I List up to ten addresses in the space above. Select the type(s) of files from the list above by chucking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> address Indicated above. <br /> 2. END will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being workod an by EHD staff may not be immediately available for revievy'. A new <br /> application may be submitted when the file IS available, <br /> 4. Any file not raturned in the same condition as released Will be reGManized by EHD Staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHO staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TI?41E <br /> DATE CONFIRMED PHONE FAX INITIALS <br />