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09-04-2fl91 11 38AM FPoDM ---- TO <br /> l ��-SAN JAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISIOR <br /> ► <br /> 344 EAST WEBER AVENUE,THIRi3 FLOOR (1J <br /> 3 St p ,2U01 STOCKTON CA 95202 <br /> ` N ..`Lh (209)458-3420 <br /> "",PUBLIC RECORDS RELEASE APPL)CATJON <br /> APPLI Al T (6 PA� c�(1M UL1 SQ-N. sustNESSiAGENCY I > NA Wng MENTAL <br /> ADD ss ��0 2 OMPA►(� '�puL tilP�fzfJ L_ ��i -E ion <br /> PHoci l �k 1 S S9q - I f�oO - FAcsIIacL �'4 l 5l $9 a 1 Cny I <br /> } TENTATIVE'APPOINTMENT DATRTIME _ /}G7i���� <br /> (PIaas'a give 7 to id s fr�dawafplication submit 1) <br /> a �t � . <br /> CHECK BOX Ta EXPEDrTF REQUEST; -W.040FEE-•RIsQUEST PROCCS D Std 3 BUSINESS DAYS <br /> •SIGN;TURF OF AP FPUCANT DATE <br /> t <br /> FILt:ADDii�E35 THIS S1DE ENO STAFF USE ONLY • <br /> PROGRAdi CLEMENTS SLARCH <br /> ;'-hi l i t i�PoRI VI i <br /> 3LP1 1LSou-n-t AiRpoR� Y+�Ipcy_ <br /> 3ti 3 �,� rt-t �ttiPor�T v v,�,i 25•(.D-=E ' 3S.a g 4L <br /> 5 u7tt ' uzPa :T A j5 z(r <br /> 3 50u11-1 F--L_ coo a QST[ ET 35 aAp 44K <br /> -2412 5 aUTH ,L 'A„C>b STRE t5-F <br /> 31» 5rx.t-rt-t E1 t�o2A+�o TiZEET- � �j.�'.Z.(v •— __ <br /> t <br /> :2`l U So+lT CC�tc 1 Fol2N lA t2EET - - _•• - <br /> ...nnc�nu �1LES <br /> UN ER13ROUND TANK(UST)CLEv <br /> A,. r StrE(LOP) I7 HOUSING ASATEMBNT 50L1D WASTE FACILITY <br /> O*-R CLEANUP 31; E(NON-LOP) D FOOD FACtUTY SOLID WASTE VEHICLE <br /> UN(PEROROUND TANK(Mot•IITOmNGjRemQvAL) CI POG KENNEL DAIRY <br /> KA�AgDOUS V,�ASTE GENERATOR O C)i"CN RANCH PKG TREATMENT PLANT <br /> T1C•{iPD PERMITTED FACILITY 13 MOTELMOTEL PUMPERTRUCIVYARDICHEMTOILETS <br /> O TAITOOUSODY PEIRCING 0 POOLISPA LAND USS APPUCATION SMS <br /> 0 'M£ iCAL WASTE FAC1LrrY a PUBLIC WATER SYSTEM LS 0Tt FR(PLEASE SPECIFY ABOVE) <br /> ,. List up to.ton addressas•in tho space above. Select the type(s)of filds from the list above by checking <br /> the appropriate box(es).:At least one file typo•MUST be selected. fax to (209)46"138 or mail tdthe <br /> 1 gddress indicated have_ <br /> z EHD will notify the applicant If any MD files exist. An appointment for review will be confirmed <br /> 1 approximately five business clays but no latsr than tbn(10)days after receipt of application.-The files <br /> will be held for a maximum Of five business days for ravlow.•Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff Islay not ba Immediately available for review. A new <br /> application may be submitted when the file is avallahle. <br /> 4. Any file not returned iui the same condition as released will be reorganized by EHD staff at the expense <br /> S. jof the applicant. Future file reviows by the same applicant may require a $37.00 deposit prior to review, <br /> "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. 1 Appiicalions received after 3:00 pm will be processed the next business day. <br /> I <br /> I ' <br /> CON IRMED APAOtNTmENT DATE TIME <br /> DAT157NFIRMED PHONE FA?( INITIALS <br /> YES NO REVIEW DATE , <br /> 614 00 14,V_QFM T❑TAL P.01 <br />