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JI-1. -uuu 1� 4�-'I.1 1-kur IL i1p.0 .t,T,'J •, ;�,m T p.,�.,., <br /> SAN JUIN COUNTYPUBLIC HEALTH SEES V <br /> 00 .. () j0 ENVIRONmeNTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR J A N 14 2000 <br /> STOCKTON CA 95202 ENVIRONMEN (AL HEALTH <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION ('ERP*"IT/ SrAVIC=S <br /> APPLICANT BUSINESS/AGENCY N ` '1-T'f�C3Y'( ,'E E` t[ � ( T. • <br /> ADDRESSL71rI_,z J-', 3 .�nLG-! <br /> PHONEFACSIMILE aro- yo ��al� <br /> 3 <br /> TENTATIVE'APPOINTMENT DATE__. TIME <br /> IPleaae eine I la to business days from date of application submdtsI) � <br /> In CHECK BOX TO EXPEDITE REQUEST-378.00 FEE-REOUE PROCESSED IN 3 USINE63 DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE O�J00 <br /> rR E ADDRESS <br /> I <br /> - C <br /> -- LSD <br /> / ENVIRONMENTAL HEALTH DIVISION FILES I-2O 'O O <br /> ti UNDERGROUND TANK LUST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILnY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 17 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> We' NOERGROUND TANK(MONITORwriREMOVAL) Cl DOGNENNEL O DAIRY <br /> �f NNARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PIANT <br /> 0 TIERED PERNfrT£D FACILITY O MOTELRIOTEL Q PUMPER TRUCKIYARDIMFIA TOILETS <br /> Cl TATT001600Y PEIRCING D POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY D PUBLIC WATER SYSTEM 0 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 box(es). At least one file type MUST be salected. Fats to(209 404-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The files <br /> will be held for maximum of five business days for review. Appointments should be Scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be Immediately available for review_ A new <br /> Application may be submitted when the Nle Is avallable. <br /> A. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future Nle reviews by the same applicant may require a$78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6. Applications received after 3:00 pm will be processed ilia neat business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE rAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> TOTAL P.02 <br />