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V <br />MARCUS H. BOLE ASSOC <br />SEP 2 2 2003 <br />N rl HEAL1 H <br />APPUCANT <br />ADDRESS <br />S30 633 0119 - $09/22/03 02:56pm p. 071 <br />SAN J( UN COUNTYPUBLIC HEALTH SERVi._-S WGoluM0CR <br />ENVIRONMENTAL HEALTH DIVISION <br />:104 EAST WEBER AVENUE, THIRD FLOOR <br />STOCKTON CA 95202 <br />(209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />BUSINESS/AGENCY <br />II/ -7-7- /.,, lf--7-i a w . ,I <br />-- _ z s t --P- C6 v <br />PHONE D 3 FA11 -CSIMILF ep 3 <br />TENTATIVE' APPOINTMENT DATE IM � G(J =� 8) 512P_/0 _ 3 067 <br />(Plrtase Ulve T to 10 bucln— d•yj from dal• ol-pplicwtlan submllloll <br />* <br />CHECK BOX TO EXPEDITE REQUEST • $89.00 FEE -REQUEST PROCES D IN J BUSINESS DAYS UA8v� <br />�C 27,� <br />SIGNATURE OF APPLICANT <br />DATE 9 22 C�a <br />VIP r AM -1— <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 ono filo type MUST be selected. Fax to 209) 464-0138 or mall to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files 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 maximum 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 revlew. A new <br />application may be submitted when the file is available. <br />4. 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 same applicant may require a $89.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />G. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />� F ' L y �uU3 <br />FNVIRONMFNTAI. HEALTFI DIVISION FILES <br />I / JI <br />Y K.1; 0MV:� <br />r-IlUNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />O OTHER CLEANUP SITE (NON•LOP) <br />❑ HOUSING ABATEMENT <br />O <br />O SQLID WASTE FACILITY <br />�� <br />FOOD FACILITY <br />C <br />O Snt_ID WASTF VEHICLE <br />Pr—HAZARDOUS WASTE GENERATOR <br />DOG KENNEL <br />❑ CHICKEN RANCH <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 ono filo type MUST be selected. Fax to 209) 464-0138 or mall to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files 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 maximum 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 revlew. A new <br />application may be submitted when the file is available. <br />4. 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 same applicant may require a $89.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />G. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />� F ' L y �uU3 <br />FNVIRONMFNTAI. HEALTFI DIVISION FILES <br />r-IlUNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />O OTHER CLEANUP SITE (NON•LOP) <br />❑ HOUSING ABATEMENT <br />O <br />O SQLID WASTE FACILITY <br />0-ONDERGROUND TANK (MONITORING/REMOVAL) <br />FOOD FACILITY <br />C <br />O Snt_ID WASTF VEHICLE <br />Pr—HAZARDOUS WASTE GENERATOR <br />DOG KENNEL <br />❑ CHICKEN RANCH <br />O DAIRY <br />O PKG TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY <br />❑ MOTEUHOTEL <br />0 PUMPER TRUCKIYARDICHEM TOILETS <br />O TATTOO/BODY PEIRCING <br />❑ POO"PA <br />O LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY <br />C PUBLIC WATER SYSTEM <br />O OTHER (PLEASE SPECIFY ABOVE) <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 ono filo type MUST be selected. Fax to 209) 464-0138 or mall to the <br />address indicated above. <br />2. EHD will notify the applicant if any EHD files 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 maximum 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 revlew. A new <br />application may be submitted when the file is available. <br />4. 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 same applicant may require a $89.00 deposit prior to review. <br />5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br />G. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />