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TO <br /> SA&..rJAQU1N OOUNTYPUBLIC HEALTH 56.oACES <br /> Ji ElgVIRONMENTAL HEALTH DIVISION <br /> -Ov 3G4 EAST WEBER AVENUE,T"IRD FLOOR <br /> STOCKTON CA 95282 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION Z, <br /> -.n <br /> APPL.ICANTE!tWc, 1A&:9 k-Q SUS24E=AGENCY C0143a9a- EA,z Try�r �C*�a 9 <br /> ADDRf3S t$Q�Ftz.A"" '#J e!s-r C-I r: S.ut�T- <br /> � <br /> PHONE (20"0 FACSfWLf ZOA) Z'S"! as3� C� ` —,CIO ? <br /> TENTATIVE*APpO1NTMEH T DA7 `^l 7✓ OO TYIRE /�M ` <br /> (F19anH Ucve 7 to sa m+shweg days Imm date of appiication suhm' 1) . <br /> CHECK BOXTQ EXPE DITH KEQUEST-5 OO FM-RUKW.STPRO SSED 1N 31OU31NES5 GAYS y <br /> SIGNATURE OF APPLICANT DATE -3 co <br /> File ADDRESS Tests svE 1-HDSTAFF USE ONLY <br /> PROGRAM ELEMaM SEARCH <br /> AJ',141r41�T1£L'�c <br /> ENVIRONMENTAL HEALTH DIVISION Fll-: ��� <br /> Li�EfRGROUND TANK(U-ST)CLEMUP SrTE(LOP) 0 HOUSING ABATEMENT• SOLIO WASTE FACILI Ty <br /> R CLEANUP STTE(140144.OPI 0 FOOD FACia.ITY O SOLID WASTE VEHICLE <br /> RGRO1ii+1D TANX(MONnORtNGIREIM OVAL) 0 DOG KENNEL 0 DAIRY <br /> WASTE GENERATOR d CHICKEN RANCH M PKG TREATMENT PLAM' <br /> TIERED PERMWTED FACILITY ❑ MQTCUHOTEIf 0 PUIWER TRUCX1YAfi=1`"]11 TOILETS <br /> 0 TAYTQQIBWY PEIRCING O POOLISPA 13 LAND USE APPLICATION SITt S <br /> ❑ MEDICAL WASTE FA,CILIT'/ R PUWJC WATER SYSTEM 0 QTHER(PLEASE SPr.CiFY ABOVE) <br /> I. List up to ten addresses in The xpacrr above. Select the typo(9)of files flan the Ilst above by checking <br /> the appropriate box(es). At least one file type MUSE'be selected. Fax W 12081 0938 4r mail t0 the <br /> ,address;Adicated abov.. <br /> 2. EHD wilt notify ttw applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(90)days after receipt of application. The files <br /> will be held fora maximum of five buSIA6 fs daps for raVlOw. Appointments should be scheduled <br /> accordingly. <br /> 3. A file ttlat is actively being worked on by EHU stiff may not be Immediately available for Tevlew. A new <br /> aGplicadon may be submitted when the file is available. <br /> 4. Any fila not returned in the same rconditlore as released will be Feorganlaeti by END Staff at the expense <br /> of the applicant. Future file revW ws by Um same appiicent may require a$78.00 deposit prior to raView. <br /> 5. "TENTATNE Appointmoot dates must be confinned with EHD staff. <br /> ti. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INMAt_S <br /> REVIEWED YES NO REVIEW DATE <br /> SH ad u avzwo <br /> T0TIFIL P.02 <br />