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Sw e <br /> 20'2oud 'luiol <br /> as=aifri r►d.ft� TO <br /> 8581800 P.01 <br /> SAN JCA�UJN COUNTYPUSLIC HEALTH SERVICES <br /> VIRpNM!~NTAL HEALTH DIVISION <br /> AUG •1 3 2001 3 EAST WESER!XENUE,TH;F?A FLOOR <br /> STOCKTON CA 95242 <br /> L`a�`i i ;' ..r• i t�a L ' (209)468-3420 <br /> PUSLIC;RECORD5 RELEASE API3LtCATION <br /> -API?L(CANT 13LJSI14ESS/AGE14CY FM414eQ� <br /> ADDRESS - 'Lv� VtEt � �9 {gl?c• sR <br /> FACSIPML>_ <br /> TENTATIVE*ApPOINTMENT DJT E VLl"�. <br /> {Please$,fie 7-t7 Q bus;no$s l TIME <br /> • 1tOtti d�hk a♦!a�PA�iGilt(at'1 SLILYPrSiCL'tt) cit t1 t <br /> CHECK BOX TO EXFEpiTE REQUEST-W.00 FEE-REQUEST pRoC]=SS4 114 BUSINESS DAYS 1 `` <br /> -SIGNATURE OF APPLICANTSL�- -�-t,. DATE <br /> FILE AooRFSS' THUS 51I2E.EHO STAFF USE.ONL <br /> PROGRAM ELEMENTS SEARCH <br /> W VaC) o3ra a a s <br /> s tv V �4��• 'L�e.'.7 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(U"CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> GTHZR GL'EAMUF SIM(I OH-41.0,P) © 1:00D EACU.ITY 0 SW15 WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGMEMkWAL) D DOG KENNEL O !DAIRY <br /> G HA2Al26Q17S WASTC GENERATOR CI cHrOXEM RANCH 0 PKG TREATMENT PLANT' <br /> G T1Eaw:PEPJAW EDFACILM O MOTEL/HOTEL 0 PUMPERTF'WNYARUfCKEMTOILETS <br /> G TATTOOmonYPEIRCING 0 f'40L!$FA - ' ' U LARD USP APPLICAMONSITE$ <br /> MEDICAL.WA8're FACII3TY D PUBLIC WATER SYSTEM CI OTHER(PLEASE SPMF!Y ASOvE) <br /> '1 List up to toll.addresses in the space above. Select the type(s)of files frpm the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected_ Fax to(209)d64 Q138 or mail to the <br /> address indicated above. <br /> 2 EHD will rtotiiy the applicant it any RHP files exit. An appointment for review will be confirmed <br /> approxirn jtely five busillessi days but no later than ten(10)days attar receipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. •A file that Is actively baing Worked erI by EHO staff may not be immediately available for review. A new <br /> AppllCatiOn tnay be submitted when the file is available. <br /> 4. Any file not returned in the setae condition a$released will be reorgariized by EHD staff at the expense <br /> Of the applicant. Future file reyiews by the same applicant may require a$87.00 daposit prior to review, <br /> 5• "TENTATIVE appointment dates must be Confirmed With Et{D stiff. <br /> E. Application*received after 3:04 prn will be procoSSed Me next business day.. <br /> CONFIRMED APPOINTMENT HATE. TIME <br /> DA'I•E CONFIRMED � PHONE FAX INITIALS. <br /> i <br /> Ra*lEWItD YES .NO REVIEW DATE ' <br /> Flt oa u a the -- <br /> TOTAL P.01 <br /> rra,ri'- -x-T0+,c+---rA Tc. ni P?ZPT. QF,!. r nr� :'IT 1:i-41-I ?Igihlfll.l N4 ic:)n TG1, fiI rinH <br />