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HEALTH SERVICES <br /> SAN JOAQUIN COUNTYPUBLIC <br /> 2 B ZOO' ENVIRONMENTAL HEALTntR DIVISION <br /> FLOOR <br /> FEB <br /> 304 EAST WEBER AVENUE, <br /> STOCKTON CA 95202 <br /> HEALTH (2091469-34zD <br /> P Ei;P11TjSER',I�tS pVBLIC RECORDS RELEASE AP�'LlDAT10N <br /> t`C* uqn BUSINESSIAGENCY <br /> APPLICANT e V� G <br /> ADDRESS I l{�CJ-l7FJ <br /> r�Q YZQ ^$Iv$�r FACSIMILE lQ1 <br /> PHONE 9 <br /> TIMB <br /> yGt C� <br /> �l <br /> 7ENTATIV E'APPOt>Vj N�g veE to t0 busing"days h°M dale O[>ppllatlon submittsq <br /> CHECK BOX TO FxpeolrE REQUEST•SeY. FEE-REQUEST PROCESSED Ik 3 BVSINE55 DAYS <br /> SIGNATURE OF APPLICANT I <br /> TH13 31Ofi EHD STAFF USE ONLY <br /> FILE ADDRESS PROCRAKELEMENiS50ARCH <br /> ?953 35a9 a4•,o , <br /> l Ul 4k (ct 35z-7 l <br /> 4 o k <br /> 3 16 r' 35x•7 M � ._ � <br /> 12 .d <br /> z � •� k� 3sz9 � . <br /> r.il )K i a+t 6 L U <br /> al S H FILL S <br /> q�� L(, �r ENVIRONMENTAL t LTH DIV1510N ES �1 <br /> f'7 ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> C UP SITE(1.091 ❑ FOOD FACILITY 11 SOLID WASTE VEHICLE <br /> �UND6RGROUMD TANK(UST) .tFAN p DAIRY <br /> O OTHER CLEANUP SITE(HON-L01P) ❑ 000 KENNEL ❑ PKa TREATMENT PLANT <br /> ❑ LINOEROROUNO TANK(MONIYORINGIREMOVAU O CttIGKEH RANCH p PUMPER TFMCKTYARDICH6M TOILETS <br /> C HAZARDOUS WASTE GENERATOR ❑ MOTEVN6T&L . ❑ LANG Of.APPLICATION SITES <br /> H <br /> ❑ TIERED PERMITTED FAC"T'I O POOUSPA p OTHER(PLEASE SPECIFY ABOYF) <br /> ❑ TATr001BODY PeIRCING 0 pUBUC WATER SYSYEra <br /> GI Nn4DICAL WASTE FACIUTT' & s of flies from the list above by checking <br /> ace abOV6. Select the typ ( 1 r�nRl 464 0 3B Of mail-t-02M <br /> t twist up to ten addresses In the space a MUST be selected. <br /> the appropriate boi(es). Al Yeast one Ate type <br /> alcals ove. ointmen!for review Will be confirmed <br /> adgms -,n - Eµ6 files exist. An aPP )tOf application. The files <br /> 2. EHD will notify the applicant if any <br /> approximately flue pusiness days but no later than ten(10)days alfter <br /> ointments should be scheduled <br /> will be held for a maximum of five business days for review. AAP <br /> accordingly. by EHD staff may not be lnimediately available for review. A new <br /> 3 A rite that 15 activeld being worked on <br /> application may besubmitted when the Ale is available. be reorganized by EHD staff at the expense <br /> 4 Any lite not returned am <br /> In the se condition as released will <br /> of the applicant. oluturo r dater,musIlyt b¢eonAmled"+filth£HDastaff. <br /> require <br /> a$87.00 deposit prior to review. <br /> 5. ^TENTATI1 appointment m wilt be processed the next business day. <br /> 6 Applications received atter 3:00 p ------------------ <br /> TIME <br /> ---- <br /> TIME �"------ <br /> ` CONFIRMED APPOINTMENT DATE INITIALS <br /> FAX I <br /> DATE CONFIRMED PHONE FA <br /> YES NC) -..REVIEW DATC _ <br /> REVIEWED TOTAL F.02 <br />