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✓/// SAN I&IJIN COUNTYPU6L.IC HEALTH H sevicEs <br /> �\ N"11RONMENTAL HEALTH DIVISION � - <br /> 304 EAST INEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> API'Lf N vii VUSINF-SSlAGENCr_ 1 iA li <br /> rr SIS <br /> A P�1Y ' 1 <br /> 1 AGSIMILfCf <br /> NCJNI= }{ LL <br /> TF_NTATiVE*APPOIW MENT DATE r �f <br /> (Please gNe 7 io 7 busing&s days from date of appiicatlas,submittal) -ThJ I 1 i <br /> s rV 1r` <br /> CHECK UGX TO FXPEDII REQU -57H_D4 FEE—R2 ST{' CIGESSt P IN«BUSINESS BAYS . <br /> DATE <br /> SIGNATURE OF APPLICANT Aft <br /> u� �j[.E ADCRIt SS <br /> C(d A e r X- <br /> " <br /> X36/, 95 ,�35�. a34/ �3K0 �� X360 3e 13 , 230 23c$ <br /> '�; � � ►�i 23'9 ,.230 "zz �s�o � � f dMI <br /> leF7f; ' <br /> r+ <br /> tt <br /> ij6Q3/ 6606� <br /> �+3 , 2 3,z34 <br /> ENVIRONMENTAL HLALTH DiV1510N "LES <br /> a� <br /> y I ] BOWING ABATEMUNT Cl SOLID WA:i FE FACILrTY <br /> UNDERGItOONf)TA14K(usT)CLEANUP S111L(LOI I FOC?[]FACILITY n St7LaP WASTE VEMCLF. <br /> +7`i'HER CLEANUP SiT�(NQN-Lop) C 1 POG FACILI ❑ nAiRY <br /> UNDERGROUND TANK(MQNITORIr3GiR.EPAOVAQ 0 DOG K14N RANCH L7 PK6 TREATMENT PLANT TO <br /> 2� 2001 <br /> }1AZARDGUS WASTE GENE=RATOR M MOTEL OTEL E l PUMPFk TRUCKIYARDICHE IAT 1 TS <br /> 0 TIERED pEWI-TTED FACILITY t] PUgL,;SPA 0 LAN❑USEAPPLICATUM Sn'E5 <br /> m TAT-yoo/90E)Y FORCING 11 PUBLIC WATER SYSTEM L7 dTHER(PLEASE SPECIII ABOVE) <br /> 0 MEDICAL WASTE FACILITY <br /> . L1st up to t>~ri addresses in the space above. Select the a MUST be e�e teci f files Fax to¢209)q64-0138 nj the list above by <br /> to tfleg <br /> thIe appropriate box(es). At least One file typ <br /> adclre---s indicated above. <br /> 2. EHi7 will notify the applicant ifany EHO files exist An appointment for review will be confirrnl=d <br /> approximately five business drays but no later than tort (10)clays after receipt of application, The files <br /> will be held for a rnaximum of five busln855 days for review. Appointments should be scheduled <br /> accordingly, <br /> 3� A fills that is actively being w13r3ced on by END staff May not be immediately available for review. new <br /> application may be submitted When the frig is available. <br /> Q. Any filo net returned in the same wndition as released will be reargI by EHD staff at the "pen3e <br /> of the app€icant. Future'510 frviews by the same applicant r ay require a $75.00 deposit prior to review_ <br /> 5. *TENTATIVE appointment date:. rnubt be Confirmed with F!H0 staff. <br /> 6. Applications received after 3.00 pm will be processed the next busitress day. <br /> CONFIRMED AF POJ TM ENT DATE, TIME — <br /> DATE CONFIRMED PHONE FAX INMALS <br /> REVIEWED YES NO REVIEW DATI~ <br /> ='H w 14 07 6--4cu <br />