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v.t! •1G rvl:y - W hUMuilt <br /> 1l/! SAN JO'AQUIN COUNTYPUBLIC HEALTH SERVICES <br /> i <br /> ENVIRONMENTAL HEATH DIVISION <br /> r 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> OUSE IC RECORDS RELEASE APPLICATION <br /> APPLJCMT DU O. ,WRJLJ��_ BUSINESSIAGWNCY:.�P� <br /> ADDRESS - cv-1 -- I <br /> }PHOPIE 2SQ`L �7-.acv Z- .1 k t=AC'81�Il1 E i �U3 8­30� -— <br /> TENTATIVE,AJ}PowTMEuT DATE '� OP TIME <br /> (pica"Siva 7 t%10 trusInean days from date of application bubrWittal) <br /> {.�_.(GCXruS <br /> H CK BOX TO PEDITE REQUT ,99 FEIr-REaU�ST FROC_ESSED IN 3 BUSINESS DAYS /may <br /> ATURE OF APPLICANT JI DATE 6�% L/ <br /> FILE ADDRESS YHIS SIDE EKE)STAFF USE ONLY <br /> t <br /> vunnRAM ELWF_9Y8 SO-ARCH <br /> Yt <br /> Eld1lIR NME H LTH DIVl5iON"FIL x l ' <br /> kon <br /> DEFt4ili8L114D TAJJ�C(t!$l')CLEANUP 51YE(Lop) 0 I-IOUSINGADATEMFENT a SOLID WASTE FACJLl9Y <br /> HER CLEAI+I[!p St7E{NaN-LOi'}: M FOOD FACiLKY CS SOLID WASTE VE141CLE <br /> DEJiGRG1.a+1D DANK SMO>,ltTAftfhtC/REmovALa R DOG KENNEL o DAIRY <br /> rAiZpOUS thIASTE GENERATOR ❑ CMCKEK PJkKC I (VAKG TR�ATMr=NT PLANT <br /> s=RED P81RMlTTF,L}fACif.i7Y ❑ {Y{07i~L(114TE1_ _ In PUMPtRiTP_UG {YARlXCFI9MT01LM <br /> 0 TATT=BODY PEIRCING c pdoL1 pA LAND USE,APpLJCA'J16N SITES <br /> 11 MEIJIGfiI WASTE FACILITY �dT�LJC WATER SYSTEM: �,"HEK(PL.EA3ESPECIFYABOYE) <br /> 1•. list up to ten addresses in the spate above. Select the type(s) of <br /> ties from the Not abovo by checking. <br /> the appropriate box{e,5}: At least one file type MUST be selected- Fax to(7091'464.0138�r mai #a ttl ' <br /> • 'address I ted abov#?. <br /> 2. EHo will notify the applicant if any EHO files exist. An appointment for rQviaYv Will be t;grJfirmed <br /> iapproxirnately rtva buslness days but no later than ten(70)days afEer receipt of application.-The files <br /> will-be bald far a maximmm offive business days for raview. Appointments should be schedUled <br /> accordingly_ <br /> 3. A file that is'actively being worked on•by F.HD staff,,slay not be lmiradiately.avaiIable for review. A MeW <br /> applica4iorJ may be submitted whon the file is avallable. <br /> 4 Any ale not raturned in xhe:same condition a$released wi.11 be reorgarf3zed by EfiD cuff attho expense <br /> of the applicant Futurei file reviews by the$ama applicant may require a$87.00 deposit prior.to review: <br /> 5. 'TENTATIVE appointmehl:dates MU;St be confirmed with EHD staff. <br /> 6. Applications received after 3:04 pm wilf be proceswd the ,text buslness day. <br /> : !DONFiRMED APFOINTMNT DATE TIME - <br /> DATE CONFIRMED PHONE FAX INITJALS <br /> Rl=kfIEWED YES .. NO REVIEW DATE <br /> . ;yrs m „ DNAilp9 - j t �r1s� asla d '0 <br /> �� t �8 IODZ_ -;.r. <br /> .z. . I}W <br /> Z <br /> l/I d 1067a�d <br />