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kw) <br /> r _ ; SAN JC'AQUIN COUNTYPUBt_!C 1-IEALI'Fi SERVICirS <br /> y � ENVIRONMF-NTq,L HEALTH DIVISIOi�i <br /> _ , <br /> X304)-AST WEBER AVENUE,THIRD'FLOO'k <br /> �:.•; ;r, ^; ST'OCKTON CA DS202 <br /> (209)465-3420 <br /> IBLIC RECORDS RELEASE APPLI,ATION <br /> APPLICANT <br /> • BU51If2:55/ GF;.AtGY II �>� �F <br /> ADO <br /> R la IZ- L �p <br /> FACSIMILL <br /> TEN'T'ATIVE'APPOINT MCtvv7nnrt: <br /> Plez:el iv ..__ TIME <br /> 0b i� <br /> b c7tol . <br /> ..Irloas da x tam data or aj3orattpn s'ubmlllalj — "— <br /> CHECK130XT0,[YPEOFTERE T <br /> t REQUEST PROCESS IN 3!ill91"r-SS DAYS f <br /> SIGNATURE;OF APPLECANT i} <br /> k k <br /> DATE ` �1 <br /> }7L>=A,R4lil. 5 THIS i$IAE L•HIS STAFF tt$L QiVLY <br /> t i PR'RQMM'LELr-WWW[TS SCARCE{ ` <br /> f <br /> tNVIRONMF-NTAL HEALTH E)IVISION?FILES r <br /> a UNRGRGROUKD TAHI{iuST)CLElU UFP 9TC(LOP) O HOUsIt4G ABATgMENT l� I <br /> I' OTI'igR CLEANUP Sz7f(tIQH-LOP L7 SOLID WASTL FACILITY <br /> FOOD FAWUTY � ❑ ISOUD WASTE Vtc}iICLE <br /> UNDERGROUND TANK tMQNiTORINCIRF_MQVAL) 4 DOG KENNEL I O 'DAISYY <br /> FiAX14RbQU3 WASTE GEN£RRYOR I O CHICKEN RANCK � lyISG 7rt1=+ATMENTPla4e[T <br /> 7i6RfD P1sRIkliT FSU J ACtI,ITY O MOTEUMbTEL i0 7l+TT{7OJBQDY P FtC1NG tPOOUSPA �AUMPER TtUCJKIYARi7ECHLrM-7p1lLiS0 IJS;APPLICATION SITFs <br /> k <br /> E3 PUBLIC I+YATLR SYS.}EIy{ p <br /> OTHER(PLEASE SPECIFY"Ov'q <br /> 'l. List up to tan addresses in tho space above, <br /> P Select <br /> tFie appropriate hax(asfeast one file tthe type(s),of tiles from the list abovo by Checking <br /> ). ,At ypc MUST be solocttcf. 9 4 i <br /> address Ingicated abovo_; kl a X ta,t , g rrlall to thQ <br /> EHD will notify the applicant if any END files exist. An appoints gent if r revic+w Yriff ba corTtifmcd <br /> approxin;6isiy five burin Pa days but no later than t ' <br /> will be held,for a Inaxlmurfl of five �{ZQ�days tt- ;receipt of application.•Tha fila5 <br /> business eta <br /> accordingly. ! ys for rovferv. Alo-PGWtMcnts should be scheduled <br /> 3 .R[iJa that is aotivaly Bain I worker!an by EHD staff may not be icr►rtlt:cii�tal av ' <br /> applicatlon,rrloy be sttbrh�tod whon.the filo is avallabte. If Y atlablo far rcviow. A new <br /> 4: An rJIQ not returned urrlod tit t17C samo candltlara as rclCasoci W' 'k �� , <br /> of the appilcatlt. Futuro f40 rovlews by the Same appllCantlmay equir a$7 pU dDstaff at the oxPen_5c <br /> epo at pr{or io review. <br /> 5. '7'ENTAT[V appalrltTrlQnt1datps must bn aonfltrrlod with lf <br /> Applications recolved alts 3:00 pm Will be processed the nOxt b'usinass day. <br /> I� <br /> CONFjRMED APPOINTMENT DX E <br /> Tl14E <br /> JOATE 00NFIRME17 F <br /> i PHONE FA;( INITIALS <br /> �Y.iFYyED YPc <br /> °''' � .. e c e r v e d T I m a—S e D•2 0"•-- 2:5 6 PM—_.____— REVIEW DATE M <br /> i <br />