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KLEINFELDER 002/a02 <br /> - . ;,7/-22/2002 10:22 FAX 209 948 06 - <br /> �. eHo iKumeea <br /> I 1 <br /> °"� `E" h SAN JOAQUIN COUNTYPUBLIC HEA TH SERVICES 3e�q3o <br /> ENVIRONMENTAL HEALTH D IVISION <br /> 304 EAST WEEER.AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 n� � <br /> k (209)468-3420D IUl <br /> PUBLIC RECORDS RELIc <br /> EASE PPLICATION <br /> � ! ,. BuSltlesSIAGENCY k K'iAL�H <br /> APPLICANT_ ENV1R0 <br /> ADDRESS: <br /> FACSIMILE—It <br /> PHONE /!r3 - TiAla1 r� �Q i <br /> 7/ � ; <br /> I da f PPI on sutrmlttst) <br /> TENTATFVE'APP'X"ENT PATE days <br /> (Please iva 7��lfusiAe � ! <br /> i r.f87.04FE£..MQUV-STPR�"F.DI 3 !N£S8DAYS 1i / <br /> ❑ CHECK B0X TO p(PVDITE REQUa_S •" ��/ <br /> IM � DATE <br /> SIGNATURE OF AQPLICANT <br /> 11. TliIS 51DP FJiD STAFI=U ONLY <br /> h - <br /> MEADDRESS PROGRAM MEN7S <br /> 'h <br /> mac/Z;LO �✓ .(; a rn:� <br /> Ip coon C <br /> Ca w+ l er t-a-n <br /> ocic;an � <br /> , <br /> MENTAL"If-AL'"'D ISION FILES <br /> ENVIRON ; <br /> i� . e SQUD WASTE IFVler CLE <br /> AB <br /> , UMDF-KROUND TANK N$T)CLEANUP 5�(LOP) 13 FOODi <br /> eS FACILITY M P1021SOLID WA5 rt IL <br /> O DAIRY i <br /> �pTH>:R CLEANUP 5�(NON-LOP} ❑ DOG KENNEL d PKG TRPAYN �(AI IEN ,PLANT T01LIFTS <br /> UNDERGROUND TANK(MONITORINGIREMOVALi ❑ CHICI EN RANCH D pUMPER MUCKlCHa <br /> rMs <br /> . $ -nomAL <br /> OR ❑ tiTPiOTLI <br /> ��ARDOUSWAS O /APECIFY ABOv <br /> F) <br /> PF�TERW P~RAITTEDFACiL� 13 POOfSPA ❑ OTHER( tp7 <br /> '❑ TATrOOIBODY FeIRCING G PUBLIC WATERS MM I <br /> L1,CAL wASTE FACILITY lect 0 etype(S)of f les from�a l'stl above by ch ct11eg <br /> List up to ten addresses in the space above. MUT a letd. Fax ° 0 46 <br /> the appropriate box(es). At least one file tYts <br /> address located aboy . . a otntment for reView-Will a conflrnled <br /> { licant if any EHD files eXist. AI' <br /> lication. The flies <br /> 2, EHD will Notify the app but no Fater than to tja)day$after receipt of ap <br /> approximately five business days s for eview. gppointxnents 5houldttbe scheduled <br /> will be held for a ma,clmum of five business day avalia4e for review. A new <br /> accordingly. worked on by EHD staff ay clot be irnmediateiy <br /> A file that is actively ubritbeini <br /> 3' be submitted when the file is avail le. nixed by 1rHD�staff at the expense <br /> application may oslt prior to review- <br /> 4. Any file not returned in the same condition as raise-" d will be reur9? a S87.00 ddp <br /> of aria applicant. Future file reviews 5y thb same aP licant mayrequire <br /> 5, 'TEWATIVE appointment dates must be Confirmed s the next business day- # <br /> *6. Applications received after 3:00 pm will be p I <br /> TIME ; k <br /> CONFIRMED APPQINYMENT DATE tNlTlAi$ <br /> PHONE FAX <br /> DXTE CONFIRMED EW DATE <br /> 44 <br /> MEWED YES NO <br />