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I <br /> 05,c22/U TTHLr.10:04 FAX 918 368 7G hLEINFELDER � ��002 <br /> o.TE rbc ErvEu �, <br /> SAN JOAQUIN CCRMIA d�R <br /> ENVIRONMENTAL_ HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> IMAY ;, N 2O0,3 STOCKTON CA 99202 <br /> (xa9) .tse-342o <br /> i; L PUBLIC RECORDS RELEASE APPLICA1-IrJMI <br /> APPLICANT Ght'I�t -4Gt,vll BUSINCSSIAGEN/CY <br /> ADDRESS l IYCLi <br /> (� <br /> ( — -- <br /> PHONE_ (91UJ 3UP_1701 FACSIMILE <br /> Q <br /> E" <br /> TENTATIV 'APPOINTMENT DATE VA�� T1 _ <br /> (Please give 7 W 10 buslness dabs from daft of applZ n subm'ltal) <br /> CHECK BOX TO EXPEDITE REQUEST- <br /> 587.00 FEE-RE4l T °ROCES8ED IN 3 BUSINESS DAYS <br /> ' f 3 <br /> SIGNATURE OF APPLICANT �aJ ti, 1:1A71: Z4) --- <br /> FILE ADDRESS THE;SIDE.EEHO$1 AFF USE ONLY <br /> PR 3GRAM ELEM t-NTq SEARCH <br /> S ` D <br /> ENVIRON* NTAL Hi:-ALTH DMS N r-ILES <br /> X(UNDERGROUND TANK(UST)CLEANUP 5n-E(LOP) ❑ HOUSING ABATEMENT ' SOLID INA3"E rACILnY <br /> V/0THER CLEANUP 51TE(NON-LOP) ❑ FOOD FACILITY C SOL1D INAS-E VEHICLE <br /> ,j=UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL DAIi;:Y <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKC.;T1-1.EA1'4ENT PLANT <br /> "W TIERED PERMITTED FACILITY ❑ MO rELhIOTEL ❑ PUAIPE:R T1tuCl/yARDICHEM TOILETS <br /> ❑ TATTOO/500Y PEIRCING d-P6OLasr'4 - - , CECIL ND IISE s)PPL.lr_,RY1ON SITES <br /> ❑ MEDICAL WASTE FACILITY d PUBLIC WATER SYSTEM ❑ OTHEE(PLF ASE:wir-cIFY ABOVE) <br /> 1. List up to ten addresses in the space above. elect the type(s) of fifes from the list alcove by,:hecKing <br /> the appropriate box(es), At least one file type VI1.15T bo selected. Fax to.(222) 64-0138 or mdil n t e <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files e:cist. An appointment for rr?view Brill be confirmed <br /> approximately five business days but no later than ton(10) days after re,::el pt av;appFC;1Uon- -:rhe files <br /> will be held for a maXimum of five busine::s days for review. Appointment: should bl!scheduled, <br /> accordingly. <br /> 3. A fila that is actively being worked on by f_HD staff may not be Immndiati)ly available for rEvlew. A nu)4 <br /> applicatlon may be submitted when the file is nvailalble. <br /> 4. Any file not returned In the same condition as released will be reorganize=d by r:.HD Staff at the expense: <br /> of tha applicant- Future file reviews by the same applicant may require tl$87.00 clf,posit prior to review. <br /> 5. (TENTATIVE appointment dates must be confirTned with END staff. <br /> 6. Applica1dons received after 3:00 pm will bap processed the next business ds,y. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED ISH ONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> a oo 14 cameo <br />