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nA11:Rt CUVLU <br /> SAN gUIN COUIVTYPUBLEC HEALTH SEIGES � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR JAN 0 2 2001 <br /> STOCKTON CA 95202 <br /> 35 <br /> (209)466-3420 NV1R0NPd,EN_F HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERMIT/SERVi-JES <br /> APPLICANT 1 4CN1 BUSINESSIAGENGY <br /> ADDRESS ��t� �[�1 J- 1 .,Yjjtc_YGLYYlF.YtFOf g S <br /> PHONE I .ZJ2 `'�{ FACSIN11LE <br /> �_.. <br /> TENTATP/E*APFOINTMENT DATE 6ul�1 �O i � Tth1E Rr"A <br /> (Please give 7 to 10 businoss da)s from dalr or application uwUmittai) <br /> CHECK BOX TO EXPEDITE REQUEST-$87,00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �x �� DATE 1/.1/01 <br /> F=ILE ADDRESS THIS SIDE EHD STAFF USEONLY <br /> YROGRANJ ELEMENTS SEARCH <br /> tJA.}'SP_rs k i 5� - cck-earl <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 6a UNDERGROUND TANK(UST)GLt ANUP SiTF_(LOP) 0 HOUSING ARATEMENT ❑ SOLID WASTE rgCILITY <br /> ❑ OTHFR CLEANUP SITE(NON-LAP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE i <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL Q DAIRY I <br /> O HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> C1 TIERED PERMITTED FACILITY Cl MOTEUHOTEL ❑ PUMPER TRUCKfYARDiCHEM TOILF'VS <br /> ❑ TATTOOIBODYPEIRCING ❑ POOLISPA ❑ LANE)USE APPLICATION SITE$ <br /> 0 NIEL)ICALWASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space ab❑va. Select the type(s)of tiles from the list above by checking <br /> the appropriate t ox(es). At ieast one file type MUST be selected. Fax to 1209? 464-0136 or mail to the <br /> address Indicated a- ove <br /> 2. F=HD will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of application, The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduied <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file raviows by the same applicant may require a 587.00 deposit prior to review. j <br /> 5. "TENTATIVE appointment dates roust be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED _ YES NO REVIEW DATE <br /> _ <br /> En ou 14 0MMO <br />