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10-11-2001 10:3bRM TG �sw' 1 rSSctilU�itd3 I' .dl <br /> 1 <br /> I SAN•JOiRQUIN COUNTYPUSUC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 FAST WE13ER AVENUE,THIRD FLOOR �-7 4-3 <br /> I <br /> STOCKT'ON CA 957.OZ <br /> (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> A l �^^ <br /> APPLICANT a tw �• Jou IMP A!Gj0 BUSINL•SSIAGL-NCY i`[� 5 l <br /> ADDRESS GU• c #/A�J�.e s.+.o G� `fi3[�'r 1 <br /> I � <br /> PHONE. i �' ��OY yY FACSIMILL• 5e�l b ( `OtI77n <br /> s <br /> TENTATIVE-APPOINYMCNT UATL•' 14>1".q A_ TIME `�a•"t <br /> / <br /> S <br /> c 7 to 40 I aSn d y ft �t7ac�y of oy�•e�+ivn.a4b,Tii{{;�►) / <br /> IS � R+� /y S n�►K�_ <br /> CH11. 'K laOX TO•EKP•CDITF REQUCST-Sl17.00 FL--L- U95T P CCSSED 1143 U NL'SS DAYS <br /> SIGNATjURE OF�P-1.1CAiNT DATE <br /> k • <br /> ' <br /> FILL'ADORN-SS THIS 5Q 9HO STAFr-USC ONLY <br /> PROG _t,kMC-NTS 9CARCH <br /> of 51� <br /> i r <br /> r, 49� e L <br /> '• +1� e �. f.nrf t' S. <br /> t <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 2kr uxoCRGPmuND rAHii(UST)CLEANUP 41TL CLOP) 0 HOU51NGADATEMF.NT O SOLID wA3Yr_r-ACIL111 <br /> 1r QTHEI CLEANUP SITE(NO1,14.0P) Q FOOD FACILITY ❑ SOLID WASTE VCHICLf` <br /> 0 UNJ3gRQA0UHO TANK(1d0NIr0RINGIRk1A0VAL) CI DDG KEmAGL Q DAIRY <br /> 9 HAZARDOUS WASTk gE;NCRATOR O CMIZICEN RANCh 13 PKG TREATMENT PLANT <br /> ❑ 71IsR[O PERMITTED FAC1WTY O MO'rVLJHbTEL 0 PUMPER T1tUCK/TAft0fCht(4 TOILETS <br /> O• TATTiPOISODY PIAIRCING O POOIJSPA 0 LAND US[!APPLICATION Srrr•S <br /> o maoiEA4 wAs-rd FAQLITY 0 PUDLIG WATJ1R.6Y4LTt_M a OTHER IPLL•ASL SVECIFY AGOVL-) <br /> �. List up to tort addressor i� the apace above. Selcut the type(s)of tiles from the list apDve by checking <br /> the appropriate box(vz): At toast one file type MUST be selected. FIx to 1209)464-0138!pr mall Ip the <br /> ' address indicated above. <br /> z. END w1f1 notify the appllt:ant if any EHD files exist. Ail appointment for review will be confirmed <br /> Aplaroxim0cly five business clays but no later than ten(1o) days after receipt of application.•Tile fills <br /> Will be hcld.for a 1Tlaxiitturn of five business days for rovicw. Appointments should be scht:dulcd <br /> accordingly. <br /> 3. A file that,is ACtivdly bcinly.worked on by r--HD staff may not be imimcdiately avaifanla for fcview. A now <br /> application.rnny lac submi4cd when the file:is available_ . <br /> 4. Arty filc'n94retufncd ill tllc same Condition as relc,aMod will be reorganized ay EHD stoft�t the expense <br /> of the applicant. Future fil!3 fcviews by the same applicant may require a WAD deposit prior to review. <br /> 5. 'TENTATIVE appointmentdat4s must be confirmed with EMD staff. <br /> G. Application's received after 3;04 peri will be proecssed the next business day, <br /> CONI=IRMED APPOIiNTMENT DATE TIME <br /> DATE C`ONF1RhIF_D PHONE FAX INITIALS <br /> REVIE _$f7 YES NO RFVIFw r►nrc , <br /> !Y • <br /> TOTAL. P.01 <br />