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I � .�7L.•G11.j1�1a:1 f _ut <br /> SAN JL,.,aUiN COUN-TYPUSLIC HEALTH SLr*£1/ICJ;S <br /> El' VIRONMENT�AL HEALTH DIVISION <br /> 3fl4 EAST WEBER AVEt4UE,Tt-itR0 FLOOR <br /> STOCKTON CA 85202 <br /> (204) 468-3420 <br /> PUBLit RECORDS RELEASE APPLICATION <br /> APpI ICA Ci 8WNESSJAGENCY Jt m1Y <br /> �pR65S � <br /> PHONE <br /> TEh1TAT11fJ`'APPQiri7MENTDATE _ [ J-,-Q Cm nMe �� ►��'1�,` <br /> {P7ca.�etptve 7 to IQ bUzinsss days from date olapplicalfprt <br /> CHECK BOX TO s_xPEprr <br /> 6 YIUEST ,DO Fu-REQ 5T PROCESSED IN:)OU51SESS DAYS <br /> SIGNATURE OF APPLICANT i <br /> DATEr J <br /> F.LE AUR<IESS 7}115 SIDE"t)STAB US&ONL - - <br /> a fd Pfipce;nrn>wL>'biE NT5 SCARcrl <br /> V • r <br /> i <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> OTHER <br /> UNDERGROUND LFANu TA�NiC(LIST) l;(_EgNUb g ;E CL-aP) d HOUSING A 3ATEMENT SOUL)WASTE FACILITY <br /> ITIEFLED <br /> )TitER GLFANUP Sill;prDN.LOP) Q FOOQ EA(;tuT'( <br /> U1VDP13GRC7UND TANK(tit jNgQR(KGM, 5UQVAQ ❑ DOG KENNEL SOLID WASTE YEH1ClL <br /> DOUS WASTE GZAERATOR Q GHIC7CEIV RANCH <br /> 0 DAIRY <br /> PERMITTED FACILiIY d MaTEL1HOT�" 0 PKC iREATMENTPLANT <br /> D. T46TTOO:BODY PEIRC[NG PUMFI R TRUICKfYARDJCHENITOILETS <br /> Q Iw--DICAI---ASTE FACIL11Y fl POQlfSPA ❑ LAND V$F- 1PL1CATi0K SITES <br /> ❑ PUBLIC WATER SYSTela ❑ 017iSR 19LEASP 9P[G1F1'ABDvt7 <br /> .1. List Up to ten atlCressesin the space abeve. Select the type(s) of ftfps fr>,m 1hQ 115E above by Chrticking <br /> ttte appropriate box(es)_'At (east ane flte type MUST ba selected. Fax to (�05} dg4.09�x yr Enol[to <br /> dress indicated above <br /> L END will notify the appllcant If any EHO files exist, An a <br /> approximately five busi ss d PPointment for review will be conf'IrMed <br /> will be he6d far a rn�cim� of ayE hUt no later than ten{90)days after recl?ipi of application.•The 111._5 <br /> accordilzgly, mess days for revterr. Al�Pair Unents should be schetiulatS <br /> U A Gla that is Rgtiyal baiY1 i <br /> Y y worked on by EHU staff may not bo ilnmadlately avi <br /> vailable tar review, A neW <br /> application may be submitted when the file is available, <br /> '. Any EIJc 10L returned in 4e same condition as released will be reorganiaod t,y E7lD staff at the expense <br /> 0• AJ}Alica�ons recei <br /> Of the applicant Future file reviews by the same Applicant may requiro a$ ci7 <br /> 87.00 doslt prior to revlew. <br /> S, 'TENTAT(Vl~ receappoint.unt dates must be cunflnnOd with EHO staff_ <br /> ved affil>r 3:00 <br /> PM will be processed V19 next business day, <br /> } <br /> PDNFIRMED APPOINTMENT DATE <br /> TIME <br /> ATE CONFIRMED <br /> PHONE INITIALS <br /> �I*VJEWED FAX <br /> r,oo t roe YES —^--«- <br /> REVIEW DATE <br /> TOTAL P.61 <br />