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ILI 19'42GOlOG P.02 <br /> ..�'" a:lw Ltw:wuwlew <br /> Uw(s tLLCEfVCUrf�r (. <br /> SAN JdAQUlN COL3NTYPUBLIC HEALTH SERVICESIN„P/i[ <br /> ENVIRONMENTAL.HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 85202 <br /> 68 <br /> (209)4 -3420 <br /> , PUBLIC RECORDS RELEASE APPUCATION <br /> ANT <br /> APPLIC �"� {}Srr .J BDSINESs/AGFNGY Ccny(a� (?�'-a�lr SFaC(/lriES, <br /> ADDRESS �`/r�-O K rC c�«,rr,.e PKry y Sur t a% PL.rksew�� L'+'9- 9'y5 dG <br /> PHONE Fz,— o2(a 79 FA1ZM" <br /> _ 1 <br /> TENTATIVE"APPOINTAYkNT UAIE TIME: <br /> {pease give 7 tP 10 tlutineas drys tram 6aYr d spyixatlon subn►ftxl) CRS ASe/� <br /> 0 CHECK 80X TO E9PEOrrE REQI Et—L� <br /> �uED IN 1 eUSWESS PAYS <br /> DATE S -17-t000 <br /> SIG1/ATUitEOF AL'P1.1t;AN7v' <br /> C <br /> FILE ADDRESS - TN1S S08 FJID STAFF USE QNiY <br /> PROGRAM ELEMENTS SEARCH <br /> v CK SfaREayq'i ,� e.e7 of SToGsr'ranl <br /> Purse y sr�✓ os <br /> ill D,5 3 v caas A 4C 45 <br /> It W Sj c <br /> I <br /> ENVIR6NMENTAL HEALTH DNISION FILE <br /> UNDERGROUND TANK(UST)CLEANUP SITE tLOP) ❑ HOMING ABATEMENT SOLID WASTE FAC1LrjT A� 2� <br /> OTHFR CLEANUP SITE(NON•LOP) Q FOOD FACILITY ❑ DAIRY VEHIC 'BOO <br /> UNDERGROUNOTANKPAOHrrORMGiKEMOVAU a DOC KENNEL <br /> )!f HAZARDOUS WASTE GENERATOR 0 CHICXID4 RANCH L) PKG TREATMENT PLANT <br /> X TIEREO PERMnYEP FAC94TY O MOTELIVIDTEL Wr PUMPER TRUCKrYARMCNEM TOaETS <br /> TATTOCYROOY PEIRCING ❑ P0OU5PA ;I LAND USE APPUCATION 31TES <br /> W MEDICAL WASTE FACUTY 17 PUBLIC WATER SYSTEM ❑ OTHER[PLEASE SPECIFY A80VE) <br /> 1_ List up to ten addresses in the space above. Select the types) of fil ram the list above checking <br /> the appropriate bax(es). At least one file type*UST be selected_ 20 464-0138 or, i to itte <br /> aqc3resfi indicated above <br /> 2. END will notify the appliWht if any EHD fifes exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days atter receipt of application. The files <br /> Will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 0. A file 1haa1 is actively being worked an by EKQ staff may not be immediately available for reV1aW. A new <br /> application may bu submitted when the file is available. <br /> 4. Any file not returned in the same condition a5 released will GB reorganized by END staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a$7a.OD deposit prior to review. <br /> 5. `TENTATIVE.appointment dates must b*Confmned with END staff. <br /> 6. Applications received after 3:00 pm will be processed the neat business day. <br /> CONFIRMED APPOINTMENT DALE TIME <br /> DATE CONFIRMED PHONE FAX INMALS <br /> REVIEWED YES NO REVIEW DATE <br /> {J m 74 <br /> TrITCY P A? <br />