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ItSC61Y4b .•. ,.M1 ..� 1 -'rCliD Lou hurMER <br /> SAN JG,,QUIN COUN TYPUBLIC AEALTH SEI-+rICES �r <br /> ENVIRONMENTAL HEAL I H DIVISION l• <br /> pD 304 IL4nn DER AVF-NUE,""IRD FLOOR <br /> c�' STOCKTON CA 9 02 � `� <br /> 1C����r <br /> PUBLIC,RECONDS RELEA F APPLICATION <br /> BliSitJ68SIAG>�iCY '� 02000 <br /> APnJCA►aIT `II <br /> L�Y � <br /> T^ VIf�ONI`,�i=h��t�i_ �:EAl.TH <br /> AI}URMtsr i i MMES <br /> PHONE � FAC$INIILE <br /> TE14TATIVE"APPOiNTMENT DATE 4iz,5 Ob TIME t o 12YNA <br /> tPbres&Dive 7 bo 14 business days morn dst6 Of appikWign subs ttd) <br /> OdCHaC1�t Isox T'o W01103TO REQU0T-$1940 PEE-1i60 t P 622FO w��1FSINF�B DAYS <br /> SIGNATURE OF APPUCANT DATE <br /> FILE ADDRESSTHtS SIDE RHO WOF u a o L.v <br /> PhtaQIt M V FMe.X 4$1E/tvgCH <br /> t Yi, ] r 1 <br /> Pei <br /> i,NVIRONMF.NTAL HEALTH OMSIGN FILES <br /> 13NDERGROUND TANK(ll'8T)CLEANUP SIU[LOP? 0 HoUISING ABATEIIti:NT 0 30UD WA.5M FAQLr1Y <br /> 1W MER C&ZAKUP 51TE N(lttLM C3 FOOD FAICILrFY In SCUD WA31` VEHICLE <br /> UNDURCiKOUND TANK(IYIQWTQMNiG9Z5MQVAL) V DOG KENNEL 0 DAIRY <br /> HAZAADOW WAST9 QP.N MTOR C1 CHICKSM RANOW G PK3 TRFAT4 ENT PLANT <br /> n nlsnaD vzRMrrncD FAcusT*r <br /> Q IdOTEWHOTIII. 0 pUmMA�cMARE CHEINKTOLC" <br /> 0 TATTnOli MY PPIR011116 0 PMUSPA c Lrwa USE APPUCATION SIYES <br /> C1 MEDICAL WASTE FALCI1Lffy 0 PUBLIC WATER SYSTEM 0 WHEK IPLE"15$PEGIFY ABOVE] <br /> 1. List up to tan addrasses in the spur-o above. 501oat 1 e tYpe(s)Of 11166 from the hat.above by checking <br /> tht appropr7ato box(es)- At IRR$t one MG type MUST a selected, x to 46"138 or <br /> mail 12 the <br /> add(esA indicabad_iW29y% <br /> 2. ZKV will notify ilia appllcarrt it any cho files exist. An appointment for review will be confirmed <br /> &pproximately tl+te bUzi n4"clays bUt no Iatar than tin(10)trays after receipt of Iapplicetlttn. Tile files <br /> will Do held for a ariead murn of five DU6i9 188 trays tar�evlew. Appointmonts should bo schodulad <br /> a0cordingly. <br /> 3. A flI8 that Is ne uvwy bainq worked on by EHo stab ty s<y not be immediately avallabla for review. A new <br /> application may be submitted when the file is aval lot la. <br /> A. Any fila riot returned In the Same eondidon as resell3 WHI be roarganhiod by EHD staff at the expense <br /> of the applicant. Future file reviews by this same appllcltt'if may requlrs a ST8.00 deposit prior to roview. <br /> 15. MUTATIVE appolntrztent datrss must be CConfir"med ter FKP sun. <br /> 6. Applicant n s received after$.-Do pm will be procasse the.next busbsozz day. <br /> CONFIRMED APPOINTMENT'DATE _ --- TIME <br /> DATE OONFtRIARD PHONE FAX INITIALS . . <br /> REVIEWED YES NO REVIEW DATE <br /> + I LI IAL N.IJP <br />