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t�OfXVUZ 1U:UU FAX U002/002 <br /> GATE Ei&MVFD - • EHD LOC NUMBER <br /> SAN J ,QUIN COUNTYPUBLIC HEALTH S WICES <br /> ENVIRONMENTAL HEALTH DIVISION -gpz <br /> 304 EAST WEBER AVENGE,THIRD FLOOR <br /> STOCKTON CA 9 202 <br /> t (209)468-342 <br /> PUBLIC RECORDS RELEA E APPLICATION <br /> APPLICANT -i os °•C —� BUSINESSrAGENCYDD llV_IL�� <br /> ADDRESS f � <br /> PHONE �- '7 S _FACSIMILE f2002 <br /> TENTATIVE'APPOINTMENT DATE q /')-/Oc;'- TIMEL1 .0 0 r N I� <br /> UF��NT HEALTH <br /> (P14ase ST a 7 t#ol�IuR,,y sr a of app 'on submittal) PERMIT/SERVICES <br /> CHECK BOX TO EXPEDITE REQUEST- EQU TPR DIN on <br /> DAYS <br /> SIGNATURE OF APPLICANT DATE -' <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> LGfhdr- 4qc A-ry e _ <br /> APN-4� ;x;7,1— Ir, --ZI ba—e JzV, CA- <br /> r <br /> U 17d Do rte.,,; c Arc;,.c M'c ti -r CA <br /> ENVIRONMENTAL HEALTHDIVISION FILES <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEENT ❑ SOLID WASTE FACILITY <br /> "THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ,0_,UNDERGR0UND TANK(MONITORINGIREMOVAL) Q DOG KENNEL C3 DAIRY <br /> f HAZARDOUS WASTE GENERATOR d CHICKEN RANCH E3 PKG TREATMENT PLANT <br /> TIERED PERMnTED FACILITY O MOTFIJHOTEL C3 PUMPERTRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOlBODY PEIRCING C1 P600SISA O 'LAND USE APPLICATION SITES <br /> E1 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM CI OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking <br /> the appropriate boxes). At least one file type MUST be selected. Fax to'L209)464-0138 or <br /> ima1l tohe <br /> ad0_W$ tLd_icated_above. <br /> 2. END will notify the applicant if any EHD files exist. Ar appointment for review will be confirmed <br /> approximately five business days but no later than to (10)days after receipt of application. The files <br /> will be held for a maximum of five business days for r view. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff m iy not be immediately available for review. A new <br /> application may be submitted when the file is availab! . <br /> 4. Any file not returned in the sante condition as release I will be reorganized'by EH❑staff at the expense <br /> of the applicant. Future file reviews by the same appl cant may require a$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed w th EWD staff. <br /> 6. Applications received after 3.00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> PATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> sx eo 14 oM7= <br />