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07 00 03: 33p <br /> J 05 @5-�0t70 02:0`_J'fl Ff2171 71) <br /> SAM JOAQUfN COUN7YPl161-tC iiEALTH SERVICESLLV`\1' <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 3O4 EAST WEB ER AVENUE,THIRD FLOOR <br /> TOCKTON CA 951DECpQ Z ZOOO <br /> a� <br /> (209)4La-3420 <br /> fe y "r PUBLIC RECORDS RELEASE APPLICATION ENVIRONMENT HEAUH <br /> / Q <br /> t <br /> ADDRESS <br /> z F ume� _ o5 535 oysZ zo9- 333 - (o�S <br /> TENTATIVE'APPOINTMENT DATE TINE <br /> (Plsxc pine]Io 10 twmes5 as s Rpm ddte of app;:ealioe.ubmiltall <br /> CNECLC 80X TO EXPEDITE REQUEST- 4,00F 5jF/—REO, P CESSeU IN L BUSINESS DAYS <br /> 'SIGNATURE OF�APPLCgN7 � '/ /� DATE F Z 7 <br /> FILE AOORES S \I'� THIS SIDE EHD UTAFP VSE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ?3 � vrrvr o r <br /> o G( dv` JC Le I I <br /> V t--1 y t' <br /> O <br /> O <br /> ENVIRONMENTAL HEALTH DIVMION FiLeS <br /> UNDERGROUNDHCLEATANK(UST)CLEANUP SITE(LOP) 1, 11000 FACILITY <br /> ccnr Cl SOLID WAS ��V <br /> 9OTHER CLEANUP SITC(NON-LOR) D (=Opp FAC4ITY O SOLID WA5TE vL i/L/S JL(�-' (/I(�l-'- <br /> YVNDERGRDUHDIAtaKtMDNRORING.'REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> !� HAZARDOUS WASTE GENERATOR ❑ CHICKFN RANG" <br /> ❑❑❑ _ NT TE ry <br /> lAETIUCTW PE CIIJG KL ❑ PUMPERTRUCKY11=CHFMT <br /> Orr&�,1 <br /> MEDICAL WASTE FAmurY U POOUSPA ❑ LAND USE APPUCAT)ON srMs . <br /> ❑ P@fill-WATER SYSTEM D OTHER(PLEASE SPECIEY ABOVE) <br /> L List up to ten addressas in U.e cpaca abovc. Select me typels)m hies from the list above by checking <br /> the appropriate box(es). !d least One fila type MUST be selected. Fax to(209)4600138 qr mail Ip the <br /> address Indicated abovc. <br /> 2- EHD will notify the apPOCant if any EHD files exist. An appointment for r 1,,W win be confirmed <br /> approximoteTy five business days but no later than ten(10)days after re6aip/of application. The tiles <br /> Will be held for a maximum or five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A filo that is acltvaty being worked on by END staff may not be immediately avdilabfe for reviaw, Anew <br /> application may be submitted W110n the file u avallable. <br /> 4. Any file net retunled in the same condition as released Will be reorganized by EHD state at the expense <br /> Of the appliCanL Future file reviowa by the aame applicant may require a$78,00 deposit prior to review. <br /> 'TENTATIVE appointment dates must be Confirmed with EHD staff. <br /> 6, Applications received atter 3:00 pm WWI be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE _ _ TIME <br /> [DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO - REVIEW OATS <br />