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Mar.: e4 U3 0j: 48p PAGE 01 F <br /> r, E' ENVIRONm-.N-rAL HEALTH <br /> 5 <br /> f,1� 4540138 I. � KAO,_C4mUweeR <br /> '..Y � AN J�AQUIN COUNTYPUBLIC HEALTH SERVIC <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 10 <br /> MAR 2 7. 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> f1 (209)468.3420 > <br /> I i�1VIIuI�I'J.EJ1 'riEALTN <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> - 0g..9 9 3-`? 11 <br /> ip II E <br /> APPLICANT 4- Q � GENcY' `�ICk 5 1 r <br /> f; 3 0 I <br /> ADDRESS `C�� 1.1 �` J : <br /> li HOME � — Y FACSIMILE dGU <br /> 3 TIME ! k <br /> TENTATIVE-APPOINTME NT DATE <br /> ASAP <br /> IPIr]so give 710'10 bum7ness days Rom dafa of 2W'caAon Submittal) • <br /> I <br /> unt l <br /> CHF C%gOx TO E7cP1<DITE REQUEST•589.0a FE ETP CE55£O IN BUSRaE98 DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT t <br /> -1 its SIDE EHD STAFF USE ONLY <br /> ` PROGIG _ ELEMENTS SEARCH <br /> FRE ADDRESS Il # <br /> K I <br /> Q I C <br /> 1.1 I <br /> !• f <br /> It <br /> IL <br /> Iy <br /> 1.1 <br /> It <br /> If . <br /> i a:l <br /> E' <br /> E' 3 <br /> i 11 <br /> ENVIRONMEt3TAL HEALTH DIVISION FILES <br /> 0 SOLID WASTEFACILrrY . <br /> „ ❑ HOUSING ADAT ENT (3 SOLID WA.STEVEHICLE <br /> E UNDERGROUND TANK(USTI CLEANUP 817E ILQO1 p FOOD FACILKY p DAIRY <br /> Ei OTHER CLEANUP SITE INC)"-LOP) 0 pOG KENNEL p PKK TREATMENT PLANT <br /> If UNDERGROUND TANK(MONITORINGJREMOVAL) ❑ CHICKEN RANCH 0 PUMPER TRUCKNARDJCHEM TOILETS <br /> [1 HAZARDOUS WASTE GENERATOR ❑ tADTEUHOTEL LAND USE APPLICATION SITES -7. {: i <br /> TIERED PERMITTED FACILrrY ❑ jpOpUSPA OTHER(PLEASE SPECIFY ABOVE) \•' <br /> ❑ TATTOOISOCYPEIRCING O <br /> ❑ MEDICAL WASTE FACILITY type(g of files from the list above by checking <br /> =F <br /> MUST be selected. Fa l0 209 484.013 or mail to tfie <br /> List u�P to len addresses In the space above. Select the 6010 <br /> the appropriate boAes). At least one file type <br /> it Ointment for review Will be confirmed I <br /> address Indicate abo applicant I!any EHD files exist. An app lic3tion. The files <br /> 2, EHD wiil notify the app Y days attar rOGeipt of app <br /> a maximum of five business days for review• Appointments should be scheduled <br /> apprpximately flus business days 8ut;no latoT than ten(10) Y <br /> x will be held for <br /> accordingly. >rHI?staff may not be immediately ava <br /> ly being worked oilable for review. Anew <br /> 3 A file that is actively by <br /> application may be submitted when the fife is available. <br /> �a same applicant maY require a Sti9.00 deposit prior 10 review. <br /> Any file not returned In the same condition as released will be rearganlzed by E=HIa stall at the expense <br /> 4 applicant. Future file reviews by <br /> Di the app <br /> E 5 `TENTATIVE nppointment dates must be confirmed <br /> nfQ essedlthe nQ staff.usiness day. <br /> 6 Applications rOCOlved after 3:00 pm will be p <br /> i I -TINE I <br /> CONmRMED APpoINTNIENT DATE ' <br /> 3 <br /> pHOf+IE FAX INITIALS <br /> DATE COMF1RM1=O <br /> REVIEW DATE <br /> RIEVIEWED YE5 <br /> NO <br /> 4 <br /> i _ I <br /> i <br /> �i f1 <br />