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nuy Vi UZ iJ • OJ NO .UWi r .0 <br /> SAN AQUIN COUNTYPUBLIC HEALTH :RV <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EMT YVE08R AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 AUG 0 2 2002 <br /> AM (309) 4683430 <br /> , ,.�5 <br /> �Am PUBLIC RECORDS RELEASE APPLICATIC� "' E T <br /> +• yfPLICANTF;i <br /> '( V'� BUBlNIiB&AGENCY �f EGdfP ' • <br /> ADDRayal�`C�.jpr� <br /> PHONE r �G �~J ( O T ^.CL PALt$��/ gif <br /> TENTATIVE'APPOtNTMriNT DATE S/ Q TIME <br /> XCHECK <br /> (PIAafa Sv��Mfd Iro • ;qrjldhti ■ubmlft <br /> a0X TO EXPEORE REQUEST- OL -Ra PR F E NESS DAYS ^ <br /> 31GNATURE OF APPLICANT DATE <br /> FITS ADDRESS THIO EIDE RHO STAFF USE ONLY <br /> PROGRAM aLttMaHTe sEMCH <br /> 00 E L,00l e t <br /> o z 6Lan] 11 <br /> OCI <br /> G �rC <br /> 0 <br /> ENVIM%mrrNTAL HEALTH DIVISION FILES/ <br /> l y+ VNOEROROUNO TANK NST)CLGANUP srra(LOP) O HI)1181N0 ABATEMENT SOUO WASTE FACtLRY <br /> �Y OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ 8%10 WASTE VEHICLE <br /> �NDEAGRDUNO TANK(MONimitiN6IREMOVALI E3 MO KRNNPL ❑ DAIRY <br /> AZARDOUS WASTE GENERATOR (5 CHICKEN RANCH (3 PKG TREATMENT PLANT <br /> IL P TIERED PERMITTED FAGo-" In MOTEUHOTEL O PUMPER TRUCK/YARWCHEM TOI).e" <br /> \, ❑ TATTOC+e ODY POIRCING ❑ POOLAIPA 0 LAND USG APPLICATION ARES <br /> �10 O MEDICAL WASTE FACILITY ❑ PUBLIC WATYR SYSTEM ❑ OTHER(PLEASE SPECIFY AOOVe) <br /> 1. List up to ten addresses In the space above- Select the typa(s) of flies Imm the list above by checking <br /> the approprlato box(oa). At least end file type MUST be ssisated• Fax to Will 404-0136 or moll to the <br /> w address Indicated above. <br /> 2. EHD will notify the applicant If tiny HHD flies exist. An appointment far review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of application. The f11ee <br /> will be hold for a maximum of five business days for review, Appointments should be schaduied <br /> accordingly. <br /> 3. A fila that is actively twiny worked on by&HG staff may not be Immediately available for review, A naw <br /> application may be submitted when the file Is available. <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 file reviews by the some applicant may require a $89.00 deposit prior to review, <br /> $, 'TENTATIVE appointment dates must be confirmed wtth EHO start- <br /> Applications <br /> taR.Applications recelved after 3:00 pm will be processed the next business day, <br /> I <br /> CONFIRMED APPOINTMENT DATA. "ME <br /> I <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> i <br /> REVIEWED YES NQ_ REMEW0ATE <br />