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JUL-25-2002 THU 04:25 I'M SCS ENGINEERS FAX N0, 9258295493 <br />d t/ 2412002 10,36 464013r ENVIRONMENTAL. HEALT'' <br />VAI I, mulv(D <br />w SAN .)OAQUIN COUNTYPUBLiC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR ' <br />STOCKTON CA 95202 <br />021 J i..f!._ r ; ;J 1 81 0Lt (209) 468.3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />N <br />APPLtCANT`•,/5/Eja _/.&,v <br />ADDRESS 6 1kSo IZ u 1 v <br />PHONE <br />TENTATIVE" APPOINTMENT DATE <br />0 CHECK BOX TO WeDITE <br />D iNK381AGENCY Se- S % / K- f'- - <br />B�i,s`:� Zia <br />PAGStMiLt; sr"�>� S ' f 3 <br />° L T1MR <br />to 10 bu91 sa d>r to of sp ICatlon Submitta <br />O FEE - f 90EST P;% IN ausiNass DAYS <br />r, Ue <br />PAGE 02 <br />SIONATURF. OF APPLICANT <br />DA <br />THIS <br />Z % v z <br />SIiR�Y'�-5ol.owngms�i , wWea.+�...R/St"J• ftnr ' <br />•' / STAFF Use i <br />PROARM <br />SOLID WASTE FACILITY <br />/ <br />13 FOOD FACILITY <br />i, SoLIO WASTE VEHK:LI: <br />;W UNDERGROUND TANK (MONIYORINp/RCMOVAL) <br />0 DOG KNNNM <br />(�fllll►11III <br />]I®I—MIN —1 <br />i,RUIMY <br />ll§LILIIIILNIu,M�m_ <br />Q TiaRLO PERmITTEb PACILITY <br />V MOTHL/HOTRL <br />ENVIRONMENTAL HEALTH DIVISION FiLES <br />UNDERGROUND TANK (UST) CLEANUP $rrt: (LOP) 17 HOUSING A13ATFMENT <br />SOLID WASTE FACILITY <br />�: OTHER CLEANUP Srm (NON -LOP) <br />13 FOOD FACILITY <br />i, SoLIO WASTE VEHK:LI: <br />;W UNDERGROUND TANK (MONIYORINp/RCMOVAL) <br />0 DOG KNNNM <br />❑ DAIRY <br />HAZARDQU$ wA$Te; ¢ENt3t yoA <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />Q TiaRLO PERmITTEb PACILITY <br />V MOTHL/HOTRL <br />❑ PUMPSR TRUCKlYARb1CNEM TOILETS <br />d 'TA1TOO/5ODY PHIRCING <br />❑ POOLISPA <br />EJ LAND USE APPLICATION SiTES <br />IO MFOICA4 WMTE FACILITY , <br />❑ PUBLIC WATER SYSTEM <br />d OTHER (PLEASE SPECIFY ABOVE) <br />1, List up to ton addresses in the space above. Select the type(s) of files from the list above by checking <br />the appropriate box(cs), At least one file type MUST be selected. FAx_to 12091.4.64-013.8 or la�i ,1_to the <br />Addrgj!9 jngidated,gbove./ <br />2. -EHD will notify the applicant if any 'EHD flies exist. An appointment for review will be confirmed <br />approximately five business days but no later than ton (10) days after receipt of application, The files <br />will. be held for a maximum of five business days for review. Appointments should be scheduled <br />accordingly. <br />3. A file that Js actively being worked on by EHD staff may not be immediately available for review. A now <br />application may be submitted when the file is available. <br />4. Any file not returned Ili the same condition as released will be reorganized by I=HD stall at the expense <br />of the applicant. Future file reviews by the same applicant may require a $89.00 deposit prior to review. <br />5. `TENTATIVE appointment dates must be confirmed with EHD staff. <br />6. Applications received after 3;00 pm will be processed the next business day. <br />CONFiRMED APPOINTMENT DATE, TIME ' <br />DATE CONFIfrtki] PHONE FAX INITIALS <br />•REVIEWeo YES NO REVIEW DATE <br />tv <br />