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ii <br />-- 0:J-04-ZId61 11:33AM FROM TO <br />., i,l� � 111V Ilry IlUN41.q <br />=8AN JbAQUIN COUNTYPUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION <br />304 EAST WEBER AVENUE, THIRD FLOOR UJ <br />3 CFP STOCKTON CA 95202 - <br />FI (209) 468-3420 <br />Icr Ili: II 1 • :, F�FUBLIC RECORDS RELEASE APPL,)CATJON <br />APDL) ANT &1J ' eUSWESWAGENCY ?ESS �J�,V t1�iJN M�NTA-d-.1 lAdC <br />i C70 <br />PHOtiL <br />tl l CJ I (f3 oC) ' FACS)MILE ( 14 1 5 ) O g Ci- I LDD i <br />yTENTATIVE-APPOINTMPJ(TDATL'_S <br />�• I <br />�) TIME <br />(place)a g/�/ivll�e 7 to to busu,oas days tram data of appllr tion submiUal) <br />Ci <br />ECKBOXTO EXPEDRE REQUEST-$£7.,,00FFE-RHQUEvSGTPROGE55£DIN3eUS1NESS DAYS <br />SIGNATURE <br />OF APPI-ICANT DATE <br />I <br />FILE.AODRES.i THIS SIDEGRA EEO STAFF USE ONLY <br />- PROGRAM ELEMENTS SIARGH <br />AjAPb9,T TJA i <br />L144-4 <br />3LPt 14 <br />"r!-1 At R P o f KT' VAI Ad _ <br />�o��Tt l A>f�PoK VA -d, 29.40 1 D• 3S•2� 4L <br />Sou m 12Fne-r A 332• z -C• 11 <br />3y3 <br />5 <br />3 <br />'Soul -h EL_ 1Jo p srRs ET 3s.a_)o HK <br />50LTFt L 'Ai1b STrLE�"T v. i 1 <br />�lZ}i EL �oRAOo TR!✓ET � . .Zip <br />1 <br />2412 <br />3 (d <br />o - <br />Sou/ AL.IFo2Nra i2axT. - - - <br />m�,K�ti ..._........v�clnu TILES <br />240 <br />UNf�ERGROUND <br />TANK (UST) CLFA,wr s1TE (LOP) LT NOUSING ABATEMENTSOLID WASTE FACILITY <br />. <br />O <br />UN <br />ER CLEANUPS E (NON•LOF) ❑ FOOD FACUTY SODA WASTE VEHICLE <br />EROROUNDTANK(MONITDRINGIREMOVALj Q POG KENNEL DAIRY <br />HAAROOUS <br />WASTE GENERATOR o CHICKEN RANCH PKG TREATMENT PUNT <br />Tlr(:EO <br />PERMITTED FACILnY Q f4O,TELlHOTEL PUMPER TRUCKIYARDICHEM TOILETS <br />O TAjTOO180DY <br />' <br />PEIRCSNG t7 POOUSPA . — LAND USE APPLICATK)N SITES <br />❑ OTHER SPECIFY ABOVE) <br />0 'M£ <br />1CAL WASTE FACILrrY O PUBLIC WATER SYSTEM (PLEASE <br />1- <br />1 List up to ten addresses in the space above. Select the type(s) of fills from the list above by checking <br />the appropriate box(es).' At (east one file typo'MUST be selected. Pax to (209) 4640138 or mail to the <br />address indicated abovd. <br />EHD will notify the applicant if any EX0 files exist. An appointment for revlow will be confirmed <br />approximately five business days but no later than On (10) days after receipt of application. -The tiles <br />will be held for a maximum of five business days for revlow. Appointments should be scheduled <br />accordingly. <br />3. <br />A file that is actively bei»g worked on by EHD staff may not be immodiately available for review. A new <br />application may be submitted when the file is available. <br />4. <br />Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br />i <br />' of the applicant. Future f ite reviews by the same applicant may require a $37.00 deposit prior to review. <br />5. <br />`TENTATIVE appointment dates must be confirmed with END staff. <br />6. <br />Applical(ons received after 3:00 pm will be processed the next business day. <br />COO <br />1 , <br />RMED APPOINTMENT DATE TIME <br />DATEjCONF(RMED <br />• PHONE PA?C INn-IALS <br />,REVJEWgD <br />YES NO REVIEW DATE <br />TOTAL P-01 <br />.S <br />