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_2f �i3=�€�t'i1 f4i 1i� s�iL,i(. JuL+s ci.t <br /> Llai t M�l:L1Y�.D F�1 AQUIN <br /> SAN COUNTYPUBLtC HEALTH dMVICES <br /> �J ENVtRC3NME14TAL HEALTH DIVISION <br /> e- <br /> 304 EAST WESER AVENUE,THIRD FLOOR 57- <br /> STOCKTON CA 9=02 <br /> (209)466•34211 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCAWr f Lr I f 0'%J BUSdNE=AGENCY <br /> AUDREss 3 0 C' Ui-Ai"S Rmulle VC-r('4_ /// �q .-� �" c •�' <br /> PHONE FACSdNl1LE l ,t ! '^ 9Q <br /> TENTATIVE'APP9tWTNf4NT DATE TIME <br /> OPIease give Y to 90 business days from date of appkation submittal) —�- Ji u N 2 2 <br /> CHECK BOX TO EXR4DITE REQUEST-U7.00 FEE—REQU - T PROCBSS£D IBI 3 BUSINESS DAYS <br /> SIGNATURE OF APPUCAN`IT DATE <br /> FERE ADDRESS THIS SIDE END STAFF USE ONLY <br /> PROGRAM ELEMENT5_8I°'ARCH <br /> 4C 3 3 -ZZa• .Z.Z.a <br /> (� r p4 t o 22 OD 0 O0_ <br /> ® Y��� <br /> !0/7 / 0 G z X63 <br /> ® g 29 <br /> 0 S J e �i JrD <br /> M V4P ec a 3 pfo <br /> ENVIRONMENTAL HEALTH.DIVISION FILES JUN 26 2001 <br /> ND_Rf31 ID TANK(UST)CLEANUP SITE(LOP) ❑ 14OUSiNG ABATEMENT M STOLID WASTE RACILtry <br /> O7HER CLE" P SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDHRGROUHD TANK(6RdNIT4RliVGtREtROvaL) ❑ p06 KENNEL ❑ DAIRY <br /> HLDOW WASTE <br /> GENERATOR ❑ CHICKEN RAN" ❑ 1'iCG TREATMENT PLANT <br /> E3 TIERED PERMITTED FAciuTY Q MOTELFHOTEL M PUMPER TRUCWYARD/CHEM TO(LETs <br /> C3 TATTOO)BODY PEiRCING ❑ P60USPA [0 LAND USE APPUGATION SITES, <br /> ❑ MEDICAL WASTE FACILITY O PUBLIC wATER SYSTEM ❑ OTHER R'L EA3E SPECIFY ASpVE) <br /> 1. List up to ten addrisses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate bax(es). At least one file type MUST be selected. Fax to I209)4j4:0,, 2E MAii to the <br /> address Indicated above. <br /> 2. FSHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approximately five busivess days but no later than ten(10)days after receipt Of application.-The files <br /> will be held for a maximum of flys business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively'be(ng worked on by END staff my not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned ln,the same condition as released will be reorganized by EHD Staff at the expense <br /> of the,applicant. Future file reviews by the game applicant May require a$37.00 deposit prior to review. <br /> 6. 'TENTATIVE appointment dates trust be confirmed With END staff. <br /> 6. Applications received after 3:00 pm will be processed the next 4usfness day. <br /> CONFIRMED APPOINTMEIiT DATE TIME <br /> GATE CONFIRP4E,D PHONE_ FAX INITIALS <br /> REVIEWED YES NQ REVIEW DATE <br /> FRIO 12 0SWIGE <br /> TOTAL P.01 <br />