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02/01/2002 16:64 2094671118 AGE STOCK'IUy <br />SAN .i UiN COU TYPUBLIC HEALTH S ICES r"Q Locr,uMeetz <br />WLff <br />1 ENViRONM NTAL HEALTH DIVISION <br />7 6 4J^ 304 EAST WE ER AVENUE, THIRD FLOOR <br />F' ' ST CKTON CA 95202 Afr74 <br />209) 468-3420 <br />PUBLIC RECOR S RELEASE APPLICATION <br />APPLICANT V G Gi. 1r1. U 16isi ESS/AGENCY d <br />ADDRESS Al <br />j (� /� J <br />PHONE /��L/Q�ij FACS MILE / ®(/! <br />TENTATIVE" APPOINTMENT DATE TIME Ib <br />(Pleas give 7 to 10 b ' Adarom to of application submittal) <br />CHECK BOK TO EXPEDn•E REQU - 8. 0 EE - EVD IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE D% Q� <br />FILE ADDR 9SS <br />iron• <br />E E D _ A <br />1. <br />List up to ten addresses In the space abc <br />FEB -6 2002• <br />ENVIRONMENT L HEALTH DIVISION FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HO JSING A13ATEMENT <br />0 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ DOG KENNEL <br />d DAIRY <br />HAZARDOUS WASTE GENERATOR <br />to CH! KEN RANCH <br />0 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />0 MO EL/HOTEL <br />❑ PUMPER TRUCK/YARD/CHEM•TOILETS <br />TATTOO/BODY PEIRCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SATES <br />❑ MEDICAL WASTE FACIUTY <br />❑ PUE UC WATER SYSTEM <br />❑ OTHER (PLEASE SPECIFY ABOVE) <br />1. <br />List up to ten addresses In the space abc <br />the appropriate box(es). At least one file <br />address indicated above. <br />2. <br />EHD will notify the applicant if any EHD fl <br />approximately five business days but no <br />will be held for a maximum of five busine <br />accordingly, <br />3. <br />A file that is actively being worked on by <br />application may be submitted when the fi <br />4. <br />Any file not returned in the same conditic <br />of the applicant. Future file reviews by th <br />5. <br />"TENTATIVE appointment dates must be - <br />6. <br />Applications received after 3:00 pm will b <br />Select the type(s) of files from the list above by checking <br />: MUST be selected. Fax to 209) 464-0138 or mail to the <br />exist. An appointment for review will be confirmed . <br />er than ten (10) days after receipt of application. The files <br />days for review. Appointments should be scheduled <br />4D staff may not be immediately available for review, A new <br />is available. <br />as released will be reorganized by EHD staff at the expanse <br />same applicant may require a $78.00 deposit prior to review. <br />►nfirmed with EHD staff. <br />processed the next business day, <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED PHONE <br />TIME <br />REVIEWED YES NO I REVIEW DATE <br />INITIALS <br />