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SLI •-:: <br /> 05-1Er' 31 10:X19 FROM <br /> u W luU NUMOU1 <br /> �.�.: I:nCJcIVL'L <br /> SAN J04L2L81N COl,1NTYPUBLIG I-lE4L7I4 SERVICES 1,1_ <br /> .5NVIRONMENTAL HEALTH DIVISION 12— <br /> iO4 <br /> -EAST WEER AVENUE,THIRD rLooR <br /> STOCKTON CA 95202 <br /> (209) 468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> `�, ` �"1tl�, fhlt I�,I,r�� �LL�.ti�'x1 ansl'k��l��s•� <br /> APPLICANT em^ t i-e-n A11�n 4uSINESSIAGENCYw 1�, I <br /> C fw j () <br /> ADDRESS S j 6r-n-rcIl C is"t-6 i 131vd �J ic'1<,'� i�' , �Jr <br /> PHONE_.. 7 <br /> 11�� =�n J3 FAr-SPIU-E <br /> f` - <br /> TEN(TATIV E"APPOINTMENT LATE TIME <br /> r� (Picose I71vo T to 10 tagUsin tt'�)�o�pplicati0n*VbmitLat) <br /> Q CHECK ISOX TO EXPEDrTE Rr::QIJEST-4$T•ao(/FF;rz-RRLOUEST PROCESSED IN 3 BUSINESS DAYS <br /> C)1 <br /> SIGNATURE OF APPLICANT _ f�d'�E' V. �'' DATE <br /> FII,.E;ADDRESS THIS&WE EHEC STAFF USE ONLY <br /> PROGRAM ELEMENT5 SEARCH <br /> qfl N r�' lJCA <br /> ENViRoNNIEN`l'AL HEALTH DIVISION FILES <br /> C3 UNDL`RGP,0UND TANK(U$7)CI,[ANUP SITE(LOP) a HOUSING ABATEMENT 13 SOLID WASTE FACIUTY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY Q SOLID WASTE VEHICLE <br /> uNDBRGROUND TA14K(MOXJT4RIN(3eRrMOVAt_) n DOG KENNEL 1 d 1 DJURY <br /> HAZARDOUS WASTE GENERAICIA 0 CHICKEN RANCH PtCG 7RIEA7Afkf�r PLANT <br /> C] <br /> O TIERED PERMITTED FACILITY ❑ MOTELMOTEL a PUMPER TRUCKITARDICHCM TOILETS <br /> D TATTOO1130CFY PEIRCING CJ POOUSPA 0 LAND USE APPLICATION SrrES <br /> d MIMCAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM C] OTHER(PI-EASE SPECIFY A40VE) <br /> 1. 1-13t up to tern addresses iri the ?pace above. Select the type(s)of files frarin tho list a.bovu by checking <br /> the appropriate box(es),: At feast one file type MUST be s*lectad_ Fax to [209)_45W38 orailrr�to the <br /> address ihclicatecf move. s <br /> 2. EHD will notify the applic4nit if any EHD rales exist. An appointment for review wilt 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 reviaw. Appointments should be schequlect <br /> accordingly. <br /> 3, A file that is activery being worked on by EHD staff may not be immediately rlvailablo.far review. Anew <br /> appllcation I'1'lay be submilited Where the file i5 available. <br /> 4. Any fila not returned in the.same condition as released will be reorganizeb by EHD staff at the expense <br /> of the applicant_ future•fiije reviews by the same applicant may require a$87.00 deposit prior to review. <br /> S. "TENTATIVE appointrnent,dates must be confirmed with EHD staff- <br /> 6_ Applications received after•3:00 prn Will be processed the next bUsiness day. <br /> CONFIRMED APPOINFmENT DATE TIME <br /> DATE CONFIRMED PHONIC FAX INIMALS <br /> REUiE1IV)=b YES NO REVIEW DATE.'_ <br /> TOTAL P.01 <br /> 05/16/01 WED 11:27 LTX/RX NO 84291 <br />