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04-16-2001 0B S1fY'1 Ol`) TO 192594096332 P.01 <br /> v..lY lttCYAYcO LM L04IIl1eYW <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION r�,j Z65, <br /> 304 EAST WEBER AVENUI:,THIRD FLOOR <br /> STOCKTON CA 98202 <br /> �. (209)4683420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AFPLICANY4 L F Nrl fi C'0i♦ STA�ITI N HUSINR]A/AOENCY 6 EO G oic/ CD 115 1& <br /> ADDR> ssG7?5673w. 4,93 AosiTgS ?GVv� STq� I�Sp/ p/ <br /> PHONE J LS5 Jp[_T o- (6'g Z, FACSIMILE A <br /> TENTATiYE'AFPOINTMBNT DATE Z�O[ T)ME O ~Y J <br /> (Please$IVa 7 to is"Li "day,Iron daN vt applicaUon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-faT.DU FEE-REQUEST PR EDW S BUUINESS DAYS <br /> SIGNATURE OF APPLICANT 2 t/FE —C, , 1 DATE <br /> F11 I ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEAR" <br /> a /904 S ouT ro .?399.138/ Z ZO, 13 239 <br /> CC Sovr S'r. 7-0CA-7-" tZa ? <br /> Sf z3 E". c W Y To e 2 <br /> C PA R 7'� W 5 o c TO .2 b d .2fri,23 9 <br /> cpm 2 81 22 G 23 9, .1.2 <br /> - <br /> S�k 5. DZA o DdC-tZ: / 2G is o .23 0 238 iGi 22 s <br /> C a. <br /> DO [ hoc AG d x381 SO 2 a2 <br /> ' EWRONIAENTAL HEALTH DIVISION FILES UJ L60 <br /> I" (A TANK(UST)CLEW UP SITE(LOP) ❑ HOUSWO AaATOUNT tY60LID WASTE PACU-rry I N _ Ii <br /> uI DTHER CL.E/UiUP SITE(NON•LOP) ❑ FOOD FACaITY IVSOUD WASTE VEHICLE <br /> I It+ HDEROROUND TANK(MMITORiN(kdREMOVAL) P DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WATTS GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> ( TIERED PERMITTED FACILITY ❑ MOTELHOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOMODY PEtRCWG O POOLISPA ❑ LAND USE APPLICATKA!SITES <br /> r7 MEDICAL WASTE FACILRY ❑ PUBLIC WATER SYSTEM q OTHER(PL.EAS&SPECIFY ABOVE) <br /> t. List up to ten addro;sasin the space abovo. Select the type(*)of files from the list above by checking <br /> the appropriate box(es). At toast one(-it*type MUST be**l*cWd. Fax to f209) 484-Q938 or mall to the <br /> address Indicated a4ove <br /> j 2, EHD will notify the applicant H any EHD Mai) exist. An appointment for review Wid be confirmed <br /> approximately five business days but no later than ten(10) days after receipt of application. The flle5 <br /> will be held for a maximum of five busines4 days for review. Appointments should be schedulad <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD Staff may not be immediately available for ravlew. A new <br /> app)icatlon may be submitted when the fits is available. <br /> 4. Any file not r*tum*d In the same conditlon as released will be reorganized by EHD atatt at fila expense <br /> of the applicant. Future file reviews by the same applicant may require a $87.00 deposit prior to review_ <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. ApplicstionS rec*IV*d after 3:00 pm will be processed the next business day. <br /> i <br /> i CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> I <br />