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�••.c nc�SrvU Et�GUu:Ir dBpK <br /> 1.5AN JOA N COUNTYPUSLIC HEALTH SERVICE <br /> ._JL_H_ 0 7 2003 EN-.riGNMENTAL HEE,LTH DIVISION <br /> 304 EAST WEBER AVENUIz,THIRD FLOOR <br /> .;ti`i i'cE;L1 i i STOCKTON CA 95202 <br /> ,(. ' CFS (soy)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT- -L(: n(` T^BUS1NESSIAGENCY <br /> AvURESS �o��� ( <br /> PHONE Z::�L° o.-'r19 jj FA"1AI1LE <br /> TENTATIVE_`APF a1rM.1F11T DA7E 7 (t D r✓ TOME O (D b <br /> (Ploz::u give 7 to 10 1;u3 icas days from Cate of application suzmittal) <br /> Z:J C ECK BOX TO (F'd1 ee ;tEQaES'1•$78,00 FES:-REQUEST PROCE;.$8D IN 3 OU51NZSS DAYS <br /> 51GNATURE OF APPLICAI IT ',:Zl ..U- -2� DATE —7L-(10 <br /> �..�—uwr-•cssat�Isr — <br /> FI:L-ACORESS <br /> THIS S:OE EAD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> reeW <br /> v O r^c,(-Aa_. J LUIL 14 i ! <br /> El <br /> >`NVIRONMENTAL HEALTH DIVISION FILES 2003 <br /> r UNDEAGX:)UN0'rAf4IC S zj) rLEAi4UP 317E(LOP) M HOUSING?A3ATE:GENT C) SOLM WASTE FACILITY <br /> OTE!Lk C1:=ANUP Srr:g4ori-_OP) 0 FOOD FAC1LtTY G 50410 WAS7ac VEHICLE <br /> * UNL!ciiSROUND TANK;fAONI IORI:43l1k;_;4OVAL) 0 003 KENNEL u DAIRY <br /> L 1tA7ARDO1JS WASTV W!_XER l`;Oft G CHIOKEN RANCH 0 PK3 TREATYIENT PLANT <br /> A10TEI_'HOTZL C PVN:?ER TRUCK/YARD/CKEM TUILETS <br /> 0 TATTOOlSOOY PIMCING C POC-"FA M LAND NS'c APPLICATION SnZS <br /> 0 MEDICAL WASTE FACILI rY PV13LIG NATER S YSTE:A Z OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to t,•n accressss In the space above. Select Lie typa(s)of flies from the list above by checking <br /> the approp-iate k•sx(Es:). A:Fast one file type MUST he seiected. Fax to!2091 4 -01na or mail to the <br /> ac'dres=:Incf irate'.abovi: <br /> 2. EH wiJ notify th a appli:alt if any EHD fi.as exist. A.Z Apcoi,tment for review wi11 be confirmed <br /> ed <br /> fiva buainass days but no later than ten(16)days after receipt of application. ThNriies <br /> will be held for a 1la;dmum of five bt:slness days for review. Appointments should be scheduled <br /> ac:cordiigly. <br /> 3. A file that be1119 worked on by EHO staff may not be ir.Omediately available for review. A new <br /> application may I:u zu�mitted when the file Is availab'a. <br /> A. Any Me,nct roturned in tele Same condition as released wili be rearganlzed by END staff attne oxpense <br /> of tele applicant. ;suture fife reviews by the same app!icant may require a 578.00 deposit prior to review. <br /> 5. *TENTATIVE appuintr ent dates must be confirmed with I~HD staff. <br /> 8. Applications rreeeived after 3:00 pm will be processcc:the next business day. <br /> Fc0T41RMED .A,PP0lt,I1*NIENT DATE _ TIME <br /> Dli rF-CON'r1RMED ___ PHONE FAX INITIALS <br /> RE-VIEWED YES NO Rl'VIEw DATE <br /> TOTR_ P.01 <br /> Td WdSO:b© 5=00d L0 ''nl £B86 828 60Z : 'ON ONOHd s t sh i 2ud o aaZ punoar0 WOH� <br />