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G�l W:,uveUe <br /> :aAN J,3,, ^iUiN COUNTYPUBLIC HEALTH SEF2VIC <br /> JUL 0 7 2003 . ARONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE-',THIRD FLOOR <br /> STOC <br /> -iV�lili UlC�ii�.F+1 iL/i L1H STOCKTON CA 95202 IJ1 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPL1CA7iT_���d�1�_r� �r��yj.- . r�� BUS�IN�E=AGESNCY Crrny,AJ Zfrr) <br /> AC CRESS_I�.LLL�V _(��e-1 Je.2'_-rAn .l.� Lri •1 rJ32.� /i`1`.+— <br /> PriONE () b'38._4$2t2�._ FAcstnflLe�i,��i$ T <br /> TENTATIVE_APPDINTI.IEI,TDATE 'I ( c 03 TIME 000 <br /> (Plrae:e gFw i to 70 bca neva esys hom tate of apPtiq;ion suemiha0 <br /> El <br /> Cr.ECK BOX TO E:(e'e.0.7e REGUEsr.S78.CO F/EE-REQUEST PROCE;.$2D IN 7 SU61NESS DAYS 7 <br /> SIGNATUR:.OFAPPLICA11T C,--t „�}..�.Q -_ DATE <br /> FI'1 AL OF(E55 THIS SIDE EHD STAFF USE ONLY <br /> _ _ __ PROGRAM ELEMENTS SPARCH <br /> AL s( ictcul r _ 3 0 <br /> 16(00y 9 — S 1V l <br /> e _ _ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> e UNDEAGA0UND'rANI(PtL3T) ::LEANUI'SI."E(LOP) 17 HOUSING ACATE'.�E4T ❑ SOLD WASTE FACILITY <br /> OTRE4 CLZANU'Srr_.'(Not:•.oP) ❑ FOOD FACILITY v 5DL70 wAsTE VEHICLE <br /> UNDZRGROUND';ANK:tdONt iORl:•IGJRFMOVAL) ❑ DOG KENNEL v DAIRY <br /> HAZARDOUS WAe'TF:tsENEi t?OR G CHICKEN RANCH J PKD TREATMENT PLANT <br /> 7:EZD?EiAUT'.eD'ACLT'T _ M MOTEL'HOTCL C PUN?EH TP•UpyYARDICKEM TOILETS <br /> TATTOO.'BDDYPI?IRCING C POCLWA ❑ LAND VSE APPLICATION SISES <br /> MEDICAL 1YASTE FAGGJh' PC PUBLIC WATER SYSTEM {7 OTN6R(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten adcress;s In the space above. Select tTe typP.(s)at Piss from the list above by Checking <br /> the appropriate box(eao). At leas:one f la ype MVST he selected. Fax to 12091 464.01"8 or mailto th <br /> ae,dre$ ; rKl_Gate!'. aboy- <br /> 2. EiiD wiJ ratify the applicant if any EHD files exist. Al appontmenf for review will be confirmed <br /> approximatal�-fiv: bumnass days but no later than ten(10)days after receipt of application. Thefllies <br /> will be Held for a naxlmum of rive buslress days for,aview. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is a.:jv.aiy being worked on by BHO Staff may not be immediately available for review. A new <br /> application may Le submitted when the file Is availabFa. <br /> A- Any f6'e net rCturiied in the Sane Condition as released witi be reorganized by EMD Staff atthe expense <br /> of the aoplirant. suture file reviews by the same applicant may require a MAW deposit prior to review. <br /> 5. 'TENTgTiVE appuint=ent dates must be confirmed with EHD staff. <br /> 6. Applications re co ivod of ter 3:00 pm will be processec'the next business day. - <br /> FC0741RMED.APPOINTNIENT DATE TIME <br /> DATE CONMRMED PHONE — FAX INITIALS <br /> --- <br /> RFIVIEWED YES NO RIVIEWDATE <br /> TOTAL P.01 <br /> Td Wt1S0 ai0 £f)0c. Lk) £886 828 602! : 'ON 3NOHd s?sfilpuy OdaZ purm.JO <br />