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SAN JQ rIIIIIIIIIIIIIIIIIIIUIN COUNTYPUBLIC HEALTH SF '4ICES <br /> ENVIRQNMENTAL WEALTH DIVISION <br /> 304 EA:s r WSBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (2051"8.3420 - <br /> PUBLIC RECORDS RELEASE APFLiCATi <br /> ADDRESS'e! <br /> /yam Q `•�J <br /> T1=NTATIVE'APPOINTMENT DATE�� -nNE C <br /> �-� �('� � � <br /> (please give 7 to iD business days from dale of upplica4on Zubmitlau �1 'ter t�t� <br /> ❑ CNECK BOX TO EXPEOFM REQUES-r-4587.00 FEE—REQta s-'AROCEsSED jN 3 4USlNlESS DAYS <br /> ,,� o 0 <br /> 51GNATLiR1:OF APPLICANT <br /> �tff []ATE <br /> FILA ADDRESS7HlS 510E CAD STAFF USE QXLY <br /> pRCGPAM uLEMENTS SEARCH <br /> C l incl -,�kw l eve• Zv8 I ?,380 8 Z 2 <br /> r llo <br /> T rGi�f <br /> 7 <br /> .1 <br /> r <br /> o rf�-! n/1 G <br /> i• � fi- ^-f Lf� .- i <br /> r=RV1R0NMENTAL HEAX.TH DIVISION FILM r <br /> pp M lJovSIP1G ABATEMENT SOLID WASTE FAQUff ; <br /> %JN1DERGIZ,OUhD TANK OUST)C►-t'Atauia Sr1F fL 3 p Fr00D F�1CIt.ti"r E3 SOLID WASTE VEKICLE 'I <br /> 0THERCLEAN UP SITE(NON.1-OP) © DO�a Itl:1�� 0 away <br /> Q UNUIERGEiOUND TANK(M0NiTOR1NGiRr:"aV W p CHICKEN RANCH � PKG TRFATMENT PLANT <br /> ZI g{AZAF7WUS WAM OEME tATOR Q M0TE1JH rEt; ❑ pUmpEfr TRUCKfYAR=KEa!TOILETS <br /> 0 TlIIcftLd PERlr rrED FACiL XY Q POGUSPX 0 LAND USE APPL1CARON SrfES <br /> M TATTQplSODY PORCM13 M PUBLtC WATER SYSTEM Q O MER(PLEASE SPECIFY AROVE i <br /> 4 MEDICAL WASTE FACILI <br /> i. List up to ten address"it file space 211)"Q- Select tfie"(S) of files from the list above by checking <br /> the appropriate bQX(edress }_ At least cne file typo MUST be selected. Fax to(2 L46 3g ar ma�Lto tl� <br /> i d a v In#rnent for rt iew will be conFrrmed <br /> 2, EHp will notify the spplicsnt if any EHO files exist,.An$f�Pa days After receipt of application_ The files <br /> approximately fire business days but in later tlsf r r ie y Appointments should be scheduled <br /> will be held for a maximum of f"bttSirxass days for review. App <br /> accordingly- 1=HD staff may ttat be lrnrnociiately a.►aildble for review- Anew <br /> 3_ p file that is actively being worked an by � <br /> application may be submitted when the file is ava"rWbie. EHB staff at tfie eXPO. <br /> nse <br /> 4. Any fila clot returAed inthe same condition as released will be reorganized by <br /> of the applicant. Futurg file reviews by the sartaa applicant tray require a$87.00 deposit prior to reviaysr_ <br /> 5. �TENITATIVE aPpoirrtment dates must be Con'firrned.with EHO staff. <br /> Applications feceived after 3-ap pra Vill be processed the next business day. <br /> gONFIRMEOk APPOINTMENT DATE TIME <br /> �i4TE CONFIRMED <br /> 'PHONE FAX iNCTU>`>rS <br /> RVE1NEd YES NO REVIEW <br /> y1pAT� <br /> �oa u as�roa TOTAL P.02 <br /> a <br />