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SAN .1 :N COUN T YPUBLIC HEALTH SE. .CES <br /> ENVIRONMENTAL HEALTH DIVISION, <br /> 304 EAS E V <br /> T V.EB R AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �� U� �O ' 1J BUSWESS/AGENCY �� �1l � I UyL <br /> ADDRESS 35'0 (f fA,-4en (:4 awe LA0 ciD 3,51 <br /> Pl;cr< —�4q Facs1M,LE__ �.jC) <br /> ENTATIVE"APPOI�!'rMENT DA-E /O f0��—�� TIME <br /> (PICasC V VQ 7 W 110/busincassdays from date of appli"lion submittal) <br /> 2)'.ECK BOX TO EXPZ�DITE REQUES`'- P.0i FEE-REQ ST PFiOCfiS D;N 3 BUSINESS DAYS <br /> SIGNA T;UR= OF APPLICANT C �u--ti_ DATE ICJ J O <br /> ( FILE ADDRESS THIS 51DE END STAFF USE ONLY <br /> PROGRAM CUM.ENTS SEARCH i <br /> 33 (,:, <br /> 1 <br /> 1 <br /> i <br /> ENVIRONMENTAL HEATH DIVISION FILES <br /> I <br /> UNDERGROUND TANK(UST)CLE.,^:UF SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> C OT}SFR CLEANUP SITE(NON-LOP) 7 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> EI UNDERGROUND TANTS(MONt7oRRiGIREMOVAL) ❑ DOO KENNEL D DAIRY <br /> O xAiARDous WASE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> C3 TIERED PERMITTED FA:ILITY ❑ ',OTEL/HOTEL ❑ PUMPER TRUC'K/YARDICHEM TOILETS <br /> ❑ TA'y7OO/90DY?EIRCING C POOLJSPA -- G LAND USE APPLICATION SITI'S <br /> D MEbidAL W.ks-rE FACILITY G PURL:C WATER SYSTEM Q OTHER(PLEASE SPGCiFY ABOVE) <br /> 4 ' <br /> :Ice abovs. Select the type(s) of files from the list above by checking <br /> t Dne file type MUST be selected. Fax to (209) 464-0138 or mail to the <br /> I EHD files exist. An appointment for review will be confirmod <br /> but no later than ten(10) days after receipt of application. The fiies <br /> business days for revlow. Appointments should be scheduled <br /> MEMBER FDIC <br /> Central California' sCommunity Bank.., <br /> I on by EHD staff may not be irmcdiately avallablo for roview. A new <br /> Dave Boyd In the file is available. <br /> Vice President/Business Banker :Cnclition as rolaased will be reorganized by EHD staff at the expen3c <br /> Tel(209)530-1583/ Fax(209)550-5099 is by the same applicant may requiro it$87.00 deposit prior to rweiow,. <br /> wwmcounfybank.cont•dam.boyd@countybaik.com lust be confirmed with EHD staff. <br /> 0.Box 1191•Merced,Ca 95341-1191•3508McHenry Avenue•Modesto,CA 95356 IT,will be processed the next business day. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INiTIAI.S <br /> REVI--YY5D YES NO REVIZIN DATE <br />