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F_EB_ 1-2003 11:3(3 FROM: T0:4 138 P.002/002 <br /> SAN JO4 UIN COUNTYPUBLIC HEALTH SB►t�CEg 1 <br /> � ti I C'' // ENVIRONMENTAL HEALTH DIVISION <br /> �rII�L� � �_Sfi ��i D• <br /> 704 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CASS202 <br /> FEB 2 1 2003 (209) aD <br /> NVIRON UBLIC RECORDS RELEASE APPLICATION <br /> E <br /> r 6usINEWIAOENCY y— -- <br /> APPLICANT `� A <br /> ADDRESS G.�P�u Y�� ••� 3� 5"IUcnvL C.4 fir, �D� _ <br /> 9 0 �_a� 7 <br /> PHONfl FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE • � 7 mZ <br /> IMF A-/2 <br /> _ 3.-3.-�> 7d�s) <br /> (Ploaxo give 7lo�a°uslnua days frcm dek or■ppllcauon eutxnl tel) <br /> Lj n + <br /> © CHECK 60X TO FJCP£DITE REQUEST•$ao0 p�E^RrQUEST PROCESSED IN 3 6UBINESS DAYS <br /> _ DATE <br /> SIGNATURE OF APPLICANT "� <br /> 11 1 FILe"DRESS . . USE!ONL <br /> PROGRAM ELEMI NT5 SEAR H <br /> rn � - <br /> u wLo <br /> , _ <br /> W <br /> W <br /> 6 5 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Q HOUSING A6ATEMENT O SCUD WAS�1L FACILITY <br /> 'g(UNDERGROUND TANK(UST)CLEANUP SITE(t.0% Q FOOD FACILITY- Q SOLID WAG 17 VEHICLE <br /> OTH£RCLEANUPsrrE(NQN4-OPI ❑ POG KENNEL 0 DAIRY VIIF-NY PLANT <br /> UNDMGROUNO TANK(MONITORINQIRI?atOVA4) 0 CHICKEN RANCH 0 PUG TRaA <br /> HAZARDOUS WASTE GENERATOR O MonljHOTr;L ❑ PUNPER T'RVGK/YAROICHEM TOII.L'Ta� <br /> TICRFo PERMn'7E0 FACd1TYp POOL/SPA A LJWD USE APPLICATION 5= <br /> rn TATTOOIOODYPEIRCWG Q PUBLIC WATER SYSTEMC1 OTHER(PLEASB SP¢CIF1'ABOVE) <br /> O MEDICAL WASTE FACILITY ` e(v),Dr files from the list above by chnckln9 <br /> �_ List up to ten eddroaeair In the psoa above, Select theone file typo MUST be t jectad. F t20 4I6 Of r ati p?hit, <br /> the appropriate bax(ea);. <br /> Add SS Indicated ab4 . <br /> y. EHD will notify the appilcant It any EHD otos oXist Ari eppalntment for reviow w111 be 4onfirm° <br /> approximately five bus(ltieae days but no I iter Y an ton (10) days cftnunonts stroouid be schedulgdfllea <br /> will he held for a maxlrrtltm of fvq bualnoss da s for revioW. App <br /> accordingly. <br /> bte for review. A now <br /> 7. A fila that Ia activaly bolhg worked on by EHD atpfi may not be immediately a`'�ai3a <br /> appticetlon May suIla not ratu Iit ++ittod when the file Is ovallabl6. at the <br /> a. of tha applicant. Fututo fila reviews by the same applicanhe same conditiou 11181 1`6182m8d t may require reorganized E83y00 dDeposit prior to review. <br /> 5. *TE ATI appointr rant dates must be conflrrned with EHD staff. <br /> g, Applications received after 7:OD pm will by procassed'the next busineus day. <br /> CONFIRMED APPOINTMENT DATE. TIME <br /> DATE CONFIRMED PHONE FAX INn�IAi S <br /> REVIEWED YES NO REVIEW DATE. ��n <br />