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10-11-2f�1 10� I Fly✓ TG .01 <br /> CPSAN-JOf�QUIN COUNTYPUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 FAST WE13ER AVENUE,TMIRU FLOOR <br /> STOCKTON CA 95702 <br /> (209)468.3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT, �• m eUSINESSIAGL-NCY_ (- 5 !- <br /> ADaRf;s <br /> PHON$. FACStMIL�L 5 l (d <br /> TENTATIVE*APPOINYMCHT DATU' <br /> ' (PICase Qivv 7 SO 10 I sin d y t�H daft of 40 cu�ian.sub,nitlal) <br /> C4CK I30X TO.EXP.EDITF ti€QUCST-$B?.OD Fr--L-- UCs'f P CCSSED IN 7 U L'55 DAYS <br /> SIGNA41URE OF 9PP-LICANT 7 0ATE AQ <br /> ' FILL ADORLS5 THIS Slott CHD STAFIT USU ONLY <br /> P(OGRAIA eLAMCNTS SCARCH <br /> i lAv. t <br /> r, •� ole, e �� L ... <br /> f e d.• Cr!r' 5- <br /> — <br /> 4 W 77 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 2tr UNDC�GPMUND TANIS(U ST)CLEANUP AITL CLOP) Q H0U3INGA9ATEMCNT O SOLID rnASTC FACILITY <br /> 0 OTHEti CLEMUP SITE tKOHIL.OP) Q FOOD FACILITY o SOLID WASTE WHICH- <br /> 0 UNDPROADUND TANK(MON r0RINQA1kM0VAL) ❑ DOG KEKNEL M DAIRY <br /> 9 HAZARDOUS WASTF$CNCRATOR 0 CMICICEN RANCH la PKG TICEATMENT PLAINT <br /> ❑ TIE-*0 PERMITTED FACIWT'Y ❑ MOTWHOTEL Q PUMPER TRUCKITARDICMZ14 TOILETS <br /> O• TATTQovAODY POLKICING O PoolispA ❑ LAND USL'APPLICATION SITES <br /> ❑ MEGiQAl,wAs'rC FAOLITY ❑ PUuuc WATER;5YaTEM C1 OTI•UR IPLEASE SPCCIFY ADOVLI <br /> I- List up to tort addreseos i� Vic apxAcc abvvc- Sclect the typc(a)of Tlas from the list 4013Ve by ChecKing <br /> ttic appropriate box(es); At toast one file type MUST be selected, fix to 3209)404-0138 or rnpil to the <br /> I addrat,s ir1 1catcd abovr_ <br /> 2. EHD will notify the appllcant if any EHD files exist. All appointment for review will be confirmed <br /> cLpproximately five business clays but Ito later than ten(10) clays after receipt of application.-Tile tiles <br /> will be hcld.for a maximum of five business days for review. Appointments should be Schcdulcd <br /> accordingly. <br /> 3. A file that,is actively being worl(eu On by END staff May not be immcdiatcly avaiI bla for review, An w <br /> appltcatiorl'rnay be submidtcd when the file is available_. <br /> 4. Any[i1C'II~ot;retufll" in 11,Ii same Condition ass I-cleasod will be reorganized I;y EHD IStaft at the expenso <br /> of the ApptieanL Futurc filo(cyicws by tura Sarno applicant may require a¢67.00 deposit prior to review. <br /> 5. 'TENTATIVE appointmerttdatss must be Confirmed with EMD stalf. <br /> G. l Applications recciyed after 3,00 pM will be prOCessed the next business day. <br /> WNFiRMED APPOINTMENT DATE TIME <br /> DATE C`QNF1RUED PHONE FAX INITIALS <br /> REVIEVJEB Y2S NO RFVIFW nAYc - <br /> "" " " TOTAL P.01 <br />