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SAN ," NQUIN COUNTYPUSLIC MF-AI:f H S'�_`.VICI <br /> 'NVIRQNMENTAL.HEALTH DIVISI O OIO <br /> C' =4 EAST WEBER AVENUE,THIRD FLOOR <br /> 56 <br /> STOCKTON CA 05202 <br /> (209).468-3424 ; <br /> PUBLIC RECORDS RELEASE APPLICATIO .a <br /> APPLICANT cmCIS A'e�-rs BUSINESSIAGENCY L`-� �'�J����✓���'L►LtA �u <br /> ApDRESS, <br /> I�Koxz= �'�t 3 ` C3 �7�a�C51Mu C� - b <br /> TENTATIVE"APPOINTMENTDATaif 1� �) TIM€ �' AM <br /> (Plaase nivc 7 io zo ausinass days foam d3oto of applleaxian subM;1W) <br /> CHECK BOX TO EJCPEDTTZ REQUEST-$7jLW FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Cr �� <br /> FILE AbORESS <br /> y e� <br /> U61,403 <br /> nV0F• <br /> 0 <br /> ENVIRQNMFXrAL HEALTH DIVISION FILES <br /> yIfNDERGROUNDTANK(UST)CLEANUP SITE(LOP") 13 MOUSLNC ABATEMFUST 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NODI-LOP) 0 VOW FrACILITY 0 saw+wus7E vi:etiCUE <br /> UNDERGROUND TAKK[KOWTORiNGIREtAOVALI ❑ COG KENNEL n DALSM, <br /> HAZARDOUS WASTE GENT=RATpR ❑ CHICKEN RANCH M F KG TREATMENT PLANT <br /> K <br /> 0IERIrB PERMITTED GEN ITS I3 M0TEUriCTML 13 PURRTRUCKWARnICHENTMETS <br /> C7 TATTDOOSODY PEIRCING POOLMPA [3 LA1ag USF,AiPPLlCAT14H SITES <br /> 0 MEDICAL WASTE FACILITY 0 P'USLLC YVATER SYSTEM! C3 OTHIER 031"SE SPECJFV ABOVE) <br /> 1. List up to ten addresses in the spaCe above- Safeco the types)of flies'rum#tm list above by checking <br /> tate appropriate box("). At least One file type MUST be selected. Fax tee[2091864,:,.0138 Or mail tq.ihe <br /> address irldir.-&ted AbOu <br /> 2. EHD will notify the apgfteant if any EHO fifes exist. An appointment for review will be confirmed <br /> approximately fire business days but nes later than ten(10) days after receipt of application. The files <br /> will be held for a ma)dmum of five business days for review. Appointments should be:scheduled <br /> acaordlrsgly. <br /> 3. A file that is actively being worked on by EHD staff may not be imMediately available far review. A new <br /> appliCatlort may be submitted when the fele is av*iiable. <br /> 4. Arty fiie not returned in use same C6ndition as released will be reorganized by EHO staff at the expenr-e <br /> of the appiirAnL Future fills reviews by the same appliCant may require a $78.00 deposit prior to review. <br /> s. "TENTATIVE appointment date&must be confirmed with END staff. <br /> Applications received after 3.00 pm will be processed the next business day- <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED _. PHONE FAX INITIALS .. <br /> REVIEWED YES NO REVIEW HATE — <br /> F,�I o4 a YSA3AY .L.•.~ <br /> TOTRL P.02 <br />