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eta —�3�;� Drl-ar u i.U. <br /> Lri7cRECElitO <br /> 11 <br /> SAN .IQAQIJIN COl1NTYf'Uf3f-IC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD Ft-OOR JUN 2 6 ?000 <br /> I STOCKTON CA 95202 <br /> (209)469-3420 ENVIRONMENT HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PE <br /> PPLICANTy4�� L8Ut5ftVESSJkGE1�GY � <br /> PHONES ( GACSIMII E � <br /> i <br /> TENTATIVE*APPOINTMENT DATE nMF <br /> (plcal.0 give 7 to 10 businass days from dato Gf dppliGatiCn submittal) <br /> i <br /> CHECK SOX TO EXPEDITE REFMA <br /> 0 5E-RED S7 PROCESSED IN 3 BUSINESS BAYS JJ <br /> DATE ' VO <br /> SIGNATURE OF APPLICAN <br /> J'ilE ADDRESS <br /> THIS SIDE EHD STAiF U5E ONLY 33C� <br /> PROGRAM ELETAENTs SEARCH E115 j <br /> I f <br /> f <br /> Aa, sr S a C, a 3 go <br /> i azo w ,1Zi a ba 3 <br /> a <br /> x-101 21 <br /> I <br /> i <br /> ENVIRONMENTAL HEALTM 01VISION Fit-ES <br /> UNDERGROUND TANK(USn CL.EANJP SiTG(LOP) ❑ 1 OUWNG A5ATEMENT �SQUD WASTE FAGILTTY <br /> OTHER CLEANUP SITE(NCN-F.GP) C FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(N`ON(TOMNG/REMOVAL) C DOID KENNEL C HAIRY <br /> t4jkZ ARU0Us WASTE GEWRATOR ❑ CHICKEN RANCH O PKG TREATUENT PL NT <br /> r IIERI=O PERMr TED FACILITY ❑ MOTF;Lj k TEL ❑ PUMPER TRUCWYARDlCHEM TOILETS <br /> T,:rr0CtBODV PEIRCING O POOUSPA 14 LAMP USE APPLICATION SITES <br /> tSEui.CAE WASTE FACILITY 4A PUSLIC WATER SYSTEM C) OTHER(PC-EASE SPECIFY ABQVF;) <br /> 1. List up to ten addresw5 in the space above. Select the type(s) of files from the list above by checking <br /> the appropriate box(es). At Feast one filo type MUST be selected- Fax to 1209) 464.0138 or mail_�the <br /> addres- above. <br /> zi EHD wilt notify the applicant if zny 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 fifes <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> i accordingly. <br /> A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> I application may be submitted when the file is availablo. <br /> q. Any file not returned in the same condition as released will be reorganized by E O staff at the expense <br /> of t1,e applicant. Future file reviews by the Same applicant may require a$78-00 deposit prior to review. <br /> _ "TENTATIVE appointment dates must be confirmed with EHD Staff. <br /> 6. AppIPGeCEans received after 3=00 pm well be processed the next business day. <br /> I <br /> ONFIRMED APPOINTMENT DATE TIME <br /> 4 tpr4TE GONFiRMED PHONE FAX INIT(AI_S <br /> rz'~ulEwED YEs NO <br /> REVIEW DATE <br /> Tr17i-T.. P-0ti <br />