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i�l�V PJNL iX <br /> SAN&QUIN COUNTYPUBLIO HEALTFt SE GS <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468.3420 <br /> 1,` PUBLIC RECORDS RELEASE APPLICATION <br /> APP)_lcANT WkL4t'✓&F ' Nc-gAVEDC 6USINESSIAGENCY`00ttp— Ci4Pnjj%j(N <br /> APDRFSS tbS EMtjVK WW$'T M IT'D G*-tbN , C4 <br /> PHONE <br /> 23L�^ bS! FAC$1�t-r MILE�WS4 - os-38 <br /> TENTATIVE"APPOINTMENT PATE TIME <br /> (Please slug 7 10'10 iwlnoi5 dens aom dam of appilcallon submltts.t) <br /> UI-11 737 02/3,.4 <br /> © CHECK BOX TO EXPEDITR REQUEST•}6r.0 FEE-REQUEST PROCESSED IN J 9USINRSB DAYS <br /> SIGNATURE OF APPLICANT ,.,_, __.., DATE <br /> FILE ADDRESS THIS SIDE EHD STAPT U ONLY <br /> PROGRAM ELEMENT'S SEARCH <br /> racc <br /> out. F+F S . <br /> TLA <br /> AAO LO <br /> I <br /> Rte.—._ - <br /> 4 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDCROROUND TANK(UST]CLEANUP SITE iLOP) 0 HOUSING ABATEMENT X SOLID WASTE FACILITY <br /> W OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY 17 SOLID WASTE VEHICLE <br /> S UNDERGROUND TANK(MONITORMGIREMOYALi G POG KENNEL ;4oxity <br /> f$HAZARDOUS WASTE GCNERATOR kfCHJCKEN RANCH t7 PKG TREATMENT PLANT' <br /> E3 T[ERIEDPEWITTEDFAC.LITY O MPTELMOTEL D PUMPER TRUCK/YAROiCHEM TOILETS <br /> O YATTOOIBODY PEIRCING 4 PQQWPA D LAND USE APPLICATION SITES <br /> pi.MSDICAL wASTE KACILITy o PUBLIC WATERSYSTEM D OTHER(PLEASE SPECIFY ASC VE) <br /> 1, List up to ten addressAs In the epnee above. Select the types)of Hles from the list AbOVe by c CCRing <br /> the appropriate bax(es), At least one Site type MUST be seWoted. Fax to(;Q91 464-0138 or mail to the <br /> address 1ntl)ca est aODve. <br /> 2. EHD will notify the applicant it any EHD files exist. An appointment for rcvtew will b4 confirmed <br /> approximately five business days but no later than ten(40I days after receipt of application. The files <br /> wW be held for a 1neXlmUm of five q usinesa days for review. Appointments Should be 3chedulad <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be tml»ediately available for reviCW. A new <br /> application may be Submitted when the T11e Is avallAble. <br /> a. Any file not returned.in the some condition as rel¢osed Will be reorganized by EHD staff at the,expense <br /> of the applicant. Fure file review$by the same applicant may require a$87.00 deposit prior to rcvtew. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 0. Applicatlons received after 3:00 pm will be processed the next burinaeB day. <br /> CONFIRMED APPOINTMENT DATk TEME <br /> DATE CONFIRMED PHONE FAX INITIAL$ <br /> REVIEWED YES NO REVIEW DATE <br /> TQTAL F.32 <br />