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IU <br /> N JUIN COUNTYPUBLIC HEALTH SER <br /> JUIN <br /> HEALTH DIVISION WS <br /> IQ I-LU/1 304 EAS'"WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> M 2001 (209)488-3420 DD <br /> 8LIC RECORDS RELEASE APPLICATION <br /> "r7S <br /> —a-A <br /> 1 <br /> R 20 F <br /> _Cilu FACSIMILE--- PLO' <br /> 02v7 <br /> T TZZNTATIYE'APPQ1kfM9NT PATE Time <br /> ENT <br /> '(Please 91ya 7 to 10 ibua-irwss Gays from date 04 apprication submittal) <br /> CHECK SOX TO EXPEDYTE k07-W.W FEE-REQUEST ROCESSED IN31SUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 3 <br /> Fke ADDRESS DiM SILM;Wig STAFF U!3E ONI-Y <br /> PRQGR"EIEMENTZ&FARCH <br /> 27 ZRF <br /> V-7-24 T-5� <br /> vooe/210 <br /> _LA <br /> 2001 <br /> ENVIRC NIMEN AL HEALTH DIVISION FILES <br /> Pd'UNDF90RQUNV TANK ju,51)CjzAitur Zrfle(LOP) C1 liousirie AbATUMENT C3 SOUP VYA3TE r-A`01UTY <br /> Z3'MER CLEANUP SITE(NDN-LgP) 0 FOOD FAQUYY In SOLID WASTE VENtCL.E <br /> SCI UNDERGROUND TANK JMONITORINGIREMOVAL), 0 DOG KENNEL Cl DAIRY <br /> HAZARDOW WA=GF;NEFLAt0Pt 0 Gkilc?(Etd PANCh CJ FKG TPEATAWNT PLANT <br /> ❑ TIEUD P*RMrFMD FACIUTY El DAGTELJHOTEL 0 PUMPER Tizur-KNAR01CHEM TORATS <br /> 'rATTOOf5OQY REIRCING E2 POOUSPA * ' ' n LAND U3E APPLICA-fJON SITES <br /> O 1dEDLCA1.wArTer-ACtUr( 0 PUBUC WATER=TLM 0 OTHER(PLIASE SPECIFY ABOVE) <br /> List up to ten addMsses in the space above. SLqect the type(s)of files from the list above by checking <br /> the appropriate box(es). At least one file type 11 V3T be selected- Q21 I 01''l <br /> address %j2djr.;atCd bbovy. .1!1,ASZMA1_112_ft <br /> 2. ENE)W]If notify the;applicant if any ZIM 1114a exist An appointmant for review wili be confirmed <br /> approximately ftvvbusiness days but nu later than tun(10)days Uftr receipt of application. The tiles <br /> with be held for a MaXiMuM Of five business days for review. AppOintrnents should be Scheduled <br /> according ry. <br /> 3- A fife Mat Is actively being worked on by EHD staff may not be immediatvgy available for review. A now <br /> application may h�submitted when the file is available. <br /> 4. A-Y file not retvmed in the same condition as rolvased will be reorganized byr EHD Staff at the expense <br /> of the applicant. FiAti�ws <br /> I f4 reviews by the same applicant may require a$87-00 deposit prior to review. <br /> 5. *TENTATIVE 3ppoiAtment dates must be confirmed with EMD staff. <br /> 6- Applications r8C*1+ed 211cf 3.00 pm will he Procas*od Ow next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE C014FIRMIED PHONE FAX INITIALS <br /> REV MWE D Y" NO REVIEW DATE <br /> 9"gig " 9mm <br /> 4 <br /> TOTAL P.01 <br />