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U��.� i air:�r [� i+r i q c i+r..._ FU 191b:3623453 P.02 <br /> DATE FE{tirVlO r i + <br /> T.' C40 t "` SA OAQUIN COUNTYQUBLIC NEALTII - VICES I <br /> - J"' „ ENVIRONMENTAL HEALTH DIVISIOR <br /> 304 FAST WEBER AVENUE,THIRD FLOOR <br /> fi(lAR 17 20 0 STOCKTON CA 952M <br /> n (209)46a-3420 <br /> FAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> �� fauc 0 2t-so BUSIJrfESSIACLICY�� a�� * iM 1us. ai.1C <br /> 4 CA C75W <br /> ADDRESS qq`A v Ste►I T E 1 <br /> PHONE ( S FAMNLE <br /> YTj- �. <br /> TENY'ATNE`APP�O{T17HEi�lT DATE TWE <br /> (Pfeasa g++s 7 to f a puatnesa datys imam ditE of application submittIO -T--r__ <br /> CHECK BOX TO EXPEDITE REQUa FFEc—REO(EST PROCESSED IN 3 E'USVJFSS DAYS <br /> ES 0 <br /> SIGNATURE OF APPLICANT - DATE ! <br /> FRE AaQM88 'CAIS wm END 9TATF USE 0LY <br /> P%DaPAY ELEMENTS SEARCH <br /> 2 7 1 <br /> - <br /> zs L z2 z'z S. Ail PIC, <br /> ENVIRONMENTAL HEALTH OnaSION FILES <br /> iia;UNDERGROUND TANK(UST)CLEA##UP BITE(LOP) 0 HOUSLUG ADATEURNT 0 soLm MIAST!FAC1LiTY <br /> P-OTHER CLEANUP SITE(NON4-OP) 0 FOOD FAMITY 17 SOUD WA-M VEHICLE <br /> M UNDERGROUND TANK(MIOMMORINGOREMOVAL) 0 400 KENNEL O DAIRY <br /> ❑ HAZARDOUS WASTE 01WIFRATOR O CHICKEN RANCH O PKG TFWAnMNT PLANT <br /> ❑ TIERea PERmrrnm FACIlTY 0 1kMLM0TEL ❑ PAUPER TRUCWYARVCHRM TDLL-M <br /> ❑ TATTOOIHODY PEIRCMG 0 POOl1MPA ❑ LAMD USE APPLICATION SnU <br /> I3 MEDICAL WASTE FACOUTY ❑ P'UEUC WATER SYSTi:N ❑ OTHER CPLr E WSCUrY ABOIWQ <br /> 1. List up to ten addresses in the Space above- Select the type(s)of files hall Me list above by checkin <br /> the appropriate box(es). At least one fib typo MUST be selected. <br /> FddM"Ind l;AUW abfPL . <br /> 2. EMD will notify the tlpplkarlt if any EHD files eaist. Are appointment for review will be confirmed I <br /> approximately 1tva business days but no later than ten(10)days after receipt of applicatiom The files <br /> will be held for a mao kmm of five business days for review. Appointments shotAd be scheduled <br /> acc*nNngly. <br /> 3_ A fila that is acttvaly being worked on by EHD staff may not be immediately available for review. A n <br /> application may be aubraitted when till file is available. i <br /> 4. Any fHe not ratutited In the same Condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Futurs fat*reviews by the sarne applicant may requlrs a$78.00 deposit prior to revs <br /> S. 'TENTATIVE appointment date*trust be confirmed with END staff. <br /> 6. applications received after 3:00 pm will be processed the next bustntss day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INl7IALs <br /> REVIEWED YES NO REVIEW DATA; <br /> ex ov 14 <br /> TOTAL P.©2 <br />