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0111f RECEIVED <br /> SAN JCAkUlN GOUNTYPUBLIC HEALTH SERVICES � �, ��L �,; <br /> JIMVIRONMENTAL HEALTH DIVISIC N <br /> 304 EAST WE13ER AVENUE,THIRD FLOO 6 ?DOD <br /> STOCKTON CA 95202 ENVIRONMENT HEALTH <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION PERMIT/SEEU <br /> APPLICANT M0.r'I k.I,ca. (yy.%I+W-S BUSINESSIAGENCY Govta(e'r .o.r T'°"'�wp tog i 4.5� SNC <br /> ADDRESS ( 8$ Flral_v+k. GA c1S2.0b <br /> .� Oc( - ,1-4 "Q.StB FACSIMILE <br /> PHONE • <br /> TENTATIVE'APPOINTMENT DATE 71ME , <br /> (Ploase give 7 to 10 hu 67o6s days from date ut application submittal) <br /> N <br /> CHECK BOX TO EXPEDITE REQUEST-$67.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> Q <br /> • <br /> ENVIRONMENTAL HEALTH DIVISION FILES �+ <br /> / ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> LTJ UNDERGROUND TANK(U5T)CLEANUP SITE(LOP) ❑ HOUSING <br /> NG Al AT ❑ SOLID WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 0DPG KENNEL LI DAIRY <br /> Rf UNDERGROUND TANK(MONITORINGlREMOVAL) L7 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ M07EL.fF10TEL ❑ PUMPER TRUCKIYARDICHEMTOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOMPA. ,. - ❑ {.,AND USE APPLICATION SITES <br /> ❑ MEDICAL <br /> ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 Dna file type MUST be selected. re..,t_Q (2nnt a QA-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant it any EHD tiles 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 a ma)dmum 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• Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as roleased will be reorganized by EHD staff at the 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. Applications received after 3:00 pm will be processed the next business day. <br /> t;ONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> 17FVIFWFn VFR Nn OM11 M nATC <br />