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P. 2 <br /> ----Dec 15 _03_L2;_24p -,upational knowledge <br /> -,r%./114 1 1 P, rz S <br /> Ut5LIU HIzALTH $,-./,VIC <br /> ENVIRONMENTALHEALTH QIVISION <br /> 304 EAST W88ER AVFNur,,THIRD FLOOR <br /> DEC STOI�KTON CA 95202 <br /> (209)460.3420 <br /> PUBLIRECORDS RELEASE APPLICATION <br /> IW51NM/AGENCY ?-A 004 a IA; O_ <br /> AOO[(CSS <br /> 0 <br /> ! ) Y)I-�r V <br /> pmort 441s- 2 F AIj7,tM;1_C 61 <br /> �j C , _&d_ -3,i�2- <br /> TCNI'ATIVE'APPOINTHIt.N1 DATE TIME <br /> (PI0,1so <br /> -7_tV!- <br /> CHECK BOX TO EXRiiOITE ACC11, U 0 F 'e EST PIROCcssEo IN 3 aVSINCSS DAYS <br /> P12, <br /> SI(;NA7URE 01" APPLICANT DATE 4,5-/,�LF <br /> � � <br /> "LG ^DDIAC:;y TK13 SIDE GRID STAFF usr oNt Y <br /> PROGRAM ELEMENTS SIZAACH <br /> A <br /> Z <br /> h, IS <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> '4rVN0LRr,nOVN0 TANK[UST)cLlrwivp stir-ILIJP) 0 hOUSiN6 ADATEMENT 0 SOL,*WASTE FACitlrf <br /> _t7 CIMER CLCANVP5111i (NON LOP) 0 FOOD FACILITY CD 5000 WA-3 TE VC HICLr <br /> r4C)ZRCn0Vh0 TArtm(mQNITORINGIREMOVALI 0 000 KENNEL 0 OA114Y <br /> -AZARDOUS WASTE GENErIATON 0 CHICKEN RANCII 0 PKG TREATMENT PLANT <br /> IJ Ticnco PERMIT'YED FACILITY 0 MoreLiHOTI41. 0 PUMPER TRUCKfYArtQ;CHCM T011.05 <br /> 0TAI TCQIOOUY PQIRCING U POOLJ$rA 0 LANG USE.APPLICATION SiTrft <br /> 0 MC-C7.1rLL W�,`rt- FACILITY 0 01 14ER(PLEASE SPECIFY ADOVC1 <br /> 1 List up 10 ton addresses In the space above. Soloct tho typo(s) of Mas from the list abovo by chockina <br /> (lie approprlalc box(es). A( least olia (119 type MUST be selected. Fax to (209) 454-0130 of oinll to the <br /> ponrc5s Inoic:)ted above. <br /> 2. CH0 will notify the apptiennt 11 ally EHD files exist. An appointment for rvvivw will be confirrrod <br /> approximately live bUSineSS days but no 1.1tor than ton (10) days alter receipt of application. The Ides <br /> will be held for 0 M;)XIn`IUITI if live uush%v%;s days for review, Appolniencrits should be schacluloo <br /> accordingly. <br /> J. A lile thit Is ar-tivaly b Ilig worked on by EHO staff may not be Ininiodlatcly Rvivilable ter review. A now <br /> applicz0on rnty 1�e etlm;llccj whoa tho file is avalloblo. <br /> .1 Any file nol return . in the same Conditfoit as rklow%ed will be ruorganizvd by C-HD staff of the oxponso <br /> of UIQ 3pplic3lit. uture file rcvlcws by tho same zipplfCant may require a JOD,Oia deposit prior to rcvtcw. <br /> 5. 'TENTATIVE appointment dales must be confirmed with EKD staff. <br /> G. Applications received after 3:00 pin Yvill be proCcssetl the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> OATE COW!RMCL) PHONL FAX INITIALS <br /> NO <br /> ,,r_V;r-�VCD YES REVIEW OATE <br />