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. •t.�fa f ' Logi a/_i/'-� l . lJ:^: t tr. A11 i i�i � A.ib __ 3.'vl _.mss.- � �" <br /> - �•• ••• I I Ti— l u 1 9 1 6 3623354 P.f7c� <br /> OArE RECt VOD <br /> EH <br /> SA DAQUIN COUNTYPUBLiC HEALTH " .VICES <br /> }' D ENVIRONMENTAL HEALTH WVISIOV <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 4�7 <br /> MAR R 17 2000 STOCKTON CA 9&= <br /> C (209)468-3420 <br /> !- 1;�,.� r '�ALTH PUBLIC RECORDS RELEASE APPLICA7tON <br /> p'-.t i.p,ay LK�Fa` s(IswWss►art.NCY_`E?--j0--At MILL <br /> ADMEs s a� 0 Its SS I�4 RK tv�, S%A J T`F— o -G c g to Gf4 9 SB z? <br /> PRONE 1q k 102, GS"A t FACSIMILE <br /> TENTATIVE'APPOWTMAhasENTDATE + i &� t' TQAE TV <br /> (Pe piv►T t010 bL=bW5&days from deli of appi'icatum Submittal) <br /> C1 CHECK BOX TO EXPEDITE REQUO FEE-REQUEST PROCESSED IN 3 BUSINrsS DAYS <br /> ES A <br /> SIGNATURE OF APPLICANT _69 DATE <br /> FILE ADDREW Vi 31DE EHD STAFF U6E ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> 2 7 <br /> v <br /> ENVIRONMENTAL HEALTH OMSION fILFS <br /> K UNDERGROUND TANK(UST)CLEANUP SfTE(LOP) ❑ HOUSIKG AVATEMUNT a SOLID WAST!FACILrN <br /> BOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> t&UNDERGROUND TANK(MONITORjNGiRE0Ov1W ❑ 000 KENNEL ❑ DAIRY <br /> ❑ tiATARDOU3 WASTE OPUFJRATOR O CHICKEN RANCH 0 PKG TREATMENT PLAKT <br /> 0 TIERED PERMTT'TED FACtLTTY 0 NKMLAKnEL 0 PUMPER TRUCKIYARDKHCM TONS <br /> ❑ TATTOOdBODY PFJRCIKG 0 POOLISPA ❑ LAND UM APPLICATION SnES <br /> O MEDICAL WASTE FACILITY 0 PUBLIC WATER SYST15W 0 OTHER(PLEASE b'#-CIPY AB(JYE) <br /> 4_ List up to ton addresses in the spade above. Select the type(:)of files from the list above by checidn <br /> the appropriate box(es). At least one filo type MUST be selected. _F tQ 02)46"134--- #o <br /> ft-re"tndiested ak2yP . <br /> 2. EMD will notify the applicant if any EMU files exist. An appointment for review will be confirmed <br /> approXimatety five bUSlness days but no tater than ten(10)days after receipt of application. The file <br /> wits be hold for a mxxhrtum of five business days for review. Appointments should t*scheduled <br /> s=ordt ng ly. <br /> 3. A fila that is actively being worked on by EHD staff may not ba immediately avallabte for review. A n <br /> application may ba submitted when ttw file is available. <br /> 4. Any fife not ratunted in the same condition as released will be reorganized by EMU staff at the open <br /> of the applicant. Future file reviews by the sarne applicant may require a$78.00 deposit prior to revs <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the nwd business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW 0A`TE <br /> TOTAL P.©2 <br />