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05/08/2003 13:50 FAX U002 <br /> _ewz7j RECLVBP <br /> i` ;SAN �O.�UIN COUNTYPUBLIC HEALTH SE�/ICES <br /> ENVIRONMENTAL HEALTH DIVIS10fr <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> MW 0 8 N103 STOCKTON CA 96202 <br /> 209 4683420 l <br /> ; �=PUBLIC RECORDS RELEASE APP PLICATION <br /> '�'iyr>"I�C+a• Incl susrnEs:�ACENcY`-D�I�'k. �1�1vtRuvt•U�h�l �,- <br /> APPLICANT <br /> ADDRESS <br /> PHONE •'1 �30 _ FACSIMILE -I�4 1'3� • '�� •— <br /> TENTATIVE-APPOINTMENT DATE WkD " i4k Z,603 TIME <br /> (Please give 7 to 10 business clays from date ot application sabnittal) , <br /> �' <br /> ?AY:i <br /> O EXPEDITE REQUEST'-$78.00 FEE-REQ OCESSED IN 3 BUSINESS I r �7 <br /> CHECK BOX 7 <br /> SIGNATURE OF APPLICANT Gam, _,•_ DATE ----=�-8 v 3�aGs <br /> �. �..� <br /> FILE ADDRESS THIS•S(4E E dD:STA-�FF USE GNLY <br /> P1tCG61;ANG!-LEMENTS SEARCH <br /> G •S <br /> 9/r c� . oft n! <br /> I IItZ . A�.t C� a. 45 <br /> D 1 Fran L,LLwc. � Lobi � G4 <br /> ENvIRONMENTAL HEALTH DIVISION FILLS <br /> C3 soi-t1-WASTC FACII-rrY <br /> C/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 :3OLW WASTE VEHICLE <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILMY 1T DAIRY <br /> GrUNDERGROUND TANK(MONITORIN (REMOVAL) O DOG <br /> RANCH NNEL la PKG TREATMENT PLANT <br /> O HAZARDOUS WASTE GENERATOR ❑ M KEEN ANTEL 17 PUMPER TRUCKIYARDICHEM TOILETS <br /> O TIERED PERMITTED FACWTY ❑ POTELIHOoUSrA Ia LAND USE APPLICATION SITES <br /> ❑ TATTOOBODY PEiRCING o pUBUC WATER SYSTEM 13 OTHER(PLEASE SPECIFY ABOVE) <br /> O MEDICAL WASTE FACILITY <br /> List up to ten addresses In the apace above. Select the t'ype(s)of Ales tram the list abpve by checking <br /> the appropriate box(es). At least one file type MUST be selected. 1�;�to 209J•�► ;or ma-1-1A0--= <br /> addr ss I dic ted Dove O;ntment for rt:view Will be t:onfinned <br /> t2, EHD will notify the applicant if any EHD files exist. An app receiptays alter <br /> approximately five business days bus n (-ate ays for rethan ten view Appoirltm re its shouldbe schedule files <br /> will be held for a maximum of five <br /> accordingly. <br /> -013. A file that Is actively being worked on by EHD staff may not bo Imrnediat�:iy available for roview• A new <br /> application may be submitted when the file is available. <br /> released will be 4. Any file <br /> not eant. Future a In file reviews by the same applicant May require� �a.,$7.o deposit it prior to review. <br /> e condition as <br /> of the pp E' <br /> �,r,., <br /> 15. *TENTATIVE appointment dates must be cortfinned with EHD Staff. � <br /> 6. Applications received after 3:00 pm will ba processed the next business da ., � ;. <br /> I CONFIRMED APPOINTMENT DATE TIME EDATE CONFIRMEDPHONE PAX IhIITIALSIEWED• YES NO REVIEW DATES -- <br /> EH 00 14 4100 TOTAL P.02 <br />