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X+ =l. ��..n "-• it r � � ..�_.. ....._ <br /> �� • <br /> OIATc RECEIV EO \I I \�^� `• I. Et-o !r <br /> MU G HUHER <br /> 1 `I ✓ SAN SOUTYPURL-1C HEALTH SERVICOS <br /> TAL HEALTH DIVISION <br /> EP AVF-N;JE,THipm frLOOR �W <br /> i Q <br /> STOCKTON CA 93202 <br /> (209)468-3420 <br /> �NMEN �l 65PUBLIC RECORDS RELEASE APP LICATIO <br /> pp -lt rr �R <br /> PpLecANT � +✓zt' �Ufal�i� USINESSIAGENcv <br /> ADaRr=ss3io C-t"- PE <br /> FAGSIM1L5 � <br /> .I. <br /> TFNTATTVE'APPoiNTMEN'r nATE 71ME <br /> (?lease give 7 W10 business 03YZ from date Of aRPJiCation s0mmittal) <br /> CHgGK 9OX TO�PEWrE REQUEST d.DO FEE-REQUEST P OCE5SED IN S BUSINESS DAYS q <br /> SIGIVG.Yt1fZE OF APPLICANT <br /> D,C TE 1 � <br /> r,. <br /> — <br /> I <br /> FILE ADDRESS TW19 Sloe EH 'CAS USE ONLY <br /> nZ 1 1 I'1 <br /> FROG RAlN EL btENTS SEARCK <br /> i. <br /> ENVIRONMENTAL HEALTH 0IVhS10N FILES tryry <br /> uluDERGROUND TANK{U5T)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID TE FAOLffY <br /> OTHER CLEANUP SITE(NON.LOP) -FOOD FACILITY ID SOLID W,*STE VEHICLE <br /> UNDERGROUND TANK MONITORING' <br /> ❑ DOGKEI�(WEL ❑ DAIRY <br /> FIATAft> OUS V?AS7E GCt ERAYOR D CHICKLI N RANCH ❑ P'KG TRFfdT9ENT PLANT <br /> TISREC3PERMrrTED PAC1LITY Q Mo7ELIHOTEL" ❑ PUMPE UCKIYArtdicldl ,(TOIL_TS <br /> TATT001BODY MIRGING ❑ P0OLl5PA 'X LAND U APPLICATION Sri C$ <br /> MEDICAL vaASTE FACILITY r'Uat-IC WA7ER SYSTEM 0 OTHER iLEASE SPECIFY ABOVE) <br /> List cep to ten addresses in the space above. Select the type(s) of tiles front'fie list above by cher-king <br /> the appropriate box{csl. At ieast one fife t'ypc+MUST be selected. Fax to(200) 464-038 or mi�jl to the <br /> address ;ntliCat.ed above. <br /> EHD will notify the applicant if any EHO files exist. An appointment for revic-r will be confirmed <br /> 1 approximately fire busineos days but no later than ten (10) days after'receip":of apple-ation. The files <br /> will be held for a maximum of five business days for review. Appointmants i�hauld be sr_heduled <br /> v accordingiy. <br /> �. A file that's actrvaly being worked on by EHD staff may not be immediately o!vailable for review. A new <br /> l application may be submitted when the file is avait$bla, <br /> 4. Any file not returned in the same condition as released will be reorganized ki:f EHD staff at the expense <br /> of the applicant. Futurefile ravi®wS by the Sam® applicant may require a$7F.00 deposit prior to review, <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3.00 pm will be processed the next business day$ <br /> TJ� CDNFIRMRD APPOWTM=NTGATE TIME <br /> � <br /> I, GATE COlffr{ftMEfl PHONE FAX IN tALS <br /> j E'jtEVIEWED Y>"S NO RSVIEW DATE I <br /> cx ea i� ua�aeca <br /> TOTAL P.02- <br />