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TO <br /> 10-12-2000 Id9°01 FRiMD <br /> SAM joAgUIN COUNITYPUBLIC HEALTH SERL._11% <br /> ENVIRONMENTAL HEALTH pIVllS10N CCT <br /> saa EASTWEBERAVENUE,Tt-11RD FLOOR 12 2000 <br /> STOCKTON CA 95202 <br /> (209)465.3420 IRONMENT HEA H <br /> PUBLIC RECORDS RELEASE APPLICATI� <br /> 't;11yCI—, BUSINEsslAt3ENCY �. <br /> MPL1C.�.NT ! T • q � <br /> Ly <br /> q,ppZgSS ` � <br /> 72 <br /> PHONE_Qtll n <br /> FACSIMILE <br /> co TIMETENTATIVE"�4u�tTMENT DAT& <br /> lol^�3t � <br /> (Pl�asa glvs 7 ea IQ busirICSs daYS frog'date 01 aFOCatioo submltW) <br /> {J CHECK BOX 70 EXPEDITE_REQ,t3E37-$97.00 PEE—REQUEST P dCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT � <br /> It 710 STAX USE ONLY <br /> ^ _ t�Ft ADaREss pRootiAln ELEMENTS <br /> �� maw c JI 3'^ L <br /> Au <br /> vow 3=��.,L�t i✓1� �4,o Ci(I�� ,1 <br /> a <br /> ENVIRONMENTAL 1'iFAi-TN DIVISION FILES <br /> iro F <br /> 1 ❑ HOUSING ARATEtA W ❑ SOLID WASTE FACILITY <br /> UNDERGROUND TANK(u8T)CLEANUP SITE 0 ' R FoQD FACILMY [] SOLID 1MAYC�VEHICLE <br /> OTHfA CLEAN SITE(l1Q LOF)C4t I=1 DOG KENNfLL ❑ 4ANiY <br /> UNDERGROUND'TANK IM�Tt7RiKCyIKEtySWAt.) [n CHIcxEN RANCH D PKG rLRTRUCrn'PLANT rLETs <br /> KAZARQOU8 WASTE GENERATOR O VOTELMOTEL d LAND U34 AJC OCATION$1 <br /> 0 TIERED PERNIM-ED FACILITY 0 POOUSPA - - O OVMI t(p f.ASE GPECI t31 <br /> ❑ TATV04W80DY PEMCING p pufILta WATER MT1JN d oYMaER(PLEASE t3PECtFY <br /> 0 MEDICAL.WAM pAGILlTY <br /> List u to tan addresses In the space above. S910ct the types)of fl{as from the list ad�ova b Al to king <br /> 1. R N1t15T be selected. <br /> the appropriate bax(cs). At least one fila typo <br /> rtri <br /> add-Ar ca d a� lntme3lt far ravlew will be cW7f <br /> 2. I:ND will natisy the applicant if any EtiD Elias exist. An aPA° of <br /> r recslPt <br /> approximately f'sve business dszy9 but no nesstda tan <br /> afor revlew�Appays ointments should b schedu files <br /> W111 be held for a maximum of fivo bus yg <br /> accordingly. <br /> 3• A the that is actively being Ymrked.on by EHD staff may not be immediately available for twN.ie A new <br /> application may be submitted when the the is avalrablA. HD stmt tit Lila expense <br /> Any tele not rvtumea in the same con4itian as released�will <br /> nt mayrrequlre S 7.00 deposit pricy4. review. <br /> the <br /> of thO applicant lntmentIlia <br /> d=eo mus be conform dsanwaew ith EMO ff. <br /> *Tr.KTA"T$VE Of <br /> w111 be P racessed the next business day <br /> 6. APpllcatiarls recehead after S. pm <br /> TIME <br /> CONIRRMED APPOINTMENT DATE NiC1ALS <br /> PHONE FAX 1 <br /> DATE CONFIRMED <br /> YE6 [VO REVIEW DATE <br /> ( f=Vll`1fYEp QI pas <br /> 1 7 <br />