Laserfiche WebLink
�APPJJCANT <br />. scunREss_ <br />F'JiONE <br />I -R7 p i j <br />SAN J ll N GOIJ14- YPUSLIC HEALTH S ,(ICES <br />EN1rlRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AV1_=ta.UE,-njIR0 FLgQR <br />STOCKTON CA 95202 <br />(229) ase?A <br />RECORDS RELEASE APPLICATIOIW <br />BU S+tESSIAGENGY <br />(.{r4 LVE+ lu/I+LrLi <br />_12k._ r�-4 X tJ Y Jfo l FAC <br />1 SIJNILL <br />TEENT,VrJVE7 A'PQIt87t ENTDATE " -Chi Timm <br />(P,eaa'a pivc X ca 7Q hSiSiA63s di,ys 7Merf date of applicatign SRhmle�ai) ' 'r <br />CHECK sOx TO 15XPEDITE FtEYWEsT • .t Q FW - MM5T PRaCEZSFV IN 313USINESS DA'Y•S <br />'SIGNATURE OF APPLICANT <br />ENVIRONMENTAL HEALTH nivuvOm F!t_F.S <br />ONPrZ iGROUNI? TAMC (UST) CLEANUI SiM (LOP) <br />CJTF�ER G1-F.ANUP SITE �YQAn•LOPj <br />IJN.DI:RGROUND TANK (74VNiTTQR(kGMPUQVAL) <br />NAZARDQUS WASTE GENERATOR 1 <br />TtEREO PHRMr TF_o FACILITY <br />C : 7 '1TOOIBODY FEIRCM <br />Q MEDICAL WA-STiEFACIu7Y <br />I <br />3. <br />d HOUSMG AaATEMENT <br />SOLID WASTE PACILITY <br />O FOOD FACILITY <br />❑ DOG KENNEL. <br />OLID WASTE VEHIC L.1= <br />13 DAIRY <br />Q CHICK0 RANCH <br />0 MO TREALtMENT PLANT <br />® MOTE 00TEL <br />I.001japA -- - <br />Cl. PUMPER TRUCKMARDICiHEM-TOILETS <br />L7 PUBLIC WATER SYST&A <br />® LAND t1SEAPFLxcATt0K SITES <br />® OTHER (PLEASE SPECIFYASOVE) <br />List up to tent aactrk$seS in the spaco abeve. Select the type(s) of flips from the list above ley ctuacfsing <br />the appropriate box(es). At least one fife type MUST be setacted. Fast to (209) 4* kj '!8B ear ntj[al to tfia <br />dress irll�tGat@H abov,� .. <br />EHD will notlfy the applicant If any END Piles exist. An appointment for review will be confirmed <br />free bus- r)pss days but no Later than #gin 00) clays a€terreceipt of application, ,The lues <br />Wil! bd, held fQr a maximwm of five business days for review. <br />accordingly. Appointments Should be sctletiulec{ <br />A 5410 that is aati ealy baing-worked on by EKD sof may not be immadlatealy available far review. A new <br />application MaY be> subniltted When the: file is available. <br />Any RJC not returned lea tic same condition as released will be rear <br />ganiaad by E}!® staff attita experxse <br />*TENTATIVE aAi?vintrnerit dates mus# be <br />Of the applicant Future file reviews by e a same a0piic nt may require a $87.00 4012051t prior to review.cuniitmed with EiiQ staff - <br />be received affier $:pp pm Will be procaSsed the next business clay. <br />FIRMED APPOINTMENT DATE <br />TIME <br />.CONFIRMED PHONE <br />FAX INITJAL3 <br />AWED YES NO <br />REYlEW DATE <br />TOTAL. P.Idl <br />