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10-02-2Wi u2:3OPM FROM I LL , - <br /> w p► sAN JURUIN COUNTYPUBLIG HEALTH 54viC '.. <br /> ly §y ) NVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER A,VENU,E,tHIRD FLOOR <br /> STOCKTON CA 95ZD2 <br /> (209)468-3420 <br /> () ! ! P'U ilPIP RECORDS RELE=ASE APPLICATION <br /> A?PUGANi . t, QF ZY) BrU.SWESSIAGENCY DY 71(] <br /> PHONE. nFACSIMIIE <br /> . TENTATIV[-'APPDINTRIL'NII DATE <br /> (PICa51Nenc T to 10 basin sm d.ys 1f0ln dataaf application submitlar) <br /> CHUCK BOX 7d,E7(pEDITE RBQU -597 or .- t;OU T PROCESSED IN S BUSINESS DAYS tt <br /> SIGNATURE OF biPPL]CANT J� DATE IO J —L) i <br /> FILE A5UR4`S TH15 SIDE Elio STAFF12 <br /> US!_dNLY <br /> _ PROORAM FLEMLI�T13�RC�� <br /> 5V <br /> ENVIRONMENTAL <br /> ' I <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES - <br /> NOERGROUND TANK(UZT)CLEANUP SITE ILOP) )HOUSING ADA.THdENT SOLID WASTE FACI111T <br /> THER CLEANUP SITE(NON-LOP) ' 0 FOOD FACILITY $L SOLID wASTE VEHICLE <br /> U N DERGROUNO TAIAk(MCWTOKING1PEAOVAL) P DOG KENNEL <br /> iASARn0U5 WASTEiGENERATOR ❑ CHICKEN RANCH ❑ DAIRY <br /> llrrl(TMENY PUWI <br /> TIERED PERM1T1Ti�D FACILITY ❑ MOTELlHYYrEI ❑ PUMPER TRUCKryARWcRE 7 TOILETS <br /> ❑ TATkr.00IDODYPI�IRCING uO POOLfSPA ❑ LAND USE APPUCA77ON SITES <br /> +r1E-OK:AL WA.-TL FAG1LrrY PUBLIC WATER5Y5.TaM ❑ OTHER(PLEASE SPECIFY AROVF.) <br /> • List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box{¢s), At least one file type MUST be selected. Fax to(2f1)464 pf38 Or m D the <br /> addressi dicated above <br /> �- ERD Will notify the applicant if any EHD files exist. Anappointmera for review will be confirmed <br /> approximately five business days but no later than ten(90)days after receipt of application.-The files <br /> will bo held for a rrlaxiTnurj7 Of five business days for review. Appointments should be scheduled <br /> accorch"g ly. <br /> 9. A file that iz actively b¢ing wonccd on'by EHD staff may not be immedlstbl nv <br /> 4 applicationlmay be submltted when di®file is available. Y ailable for review. Anew <br /> Any Rlc not roturned in the same condition as released will bo reorganized by F-Hp staff at the expense <br /> TEN applicant Future fija rOvisws by the same applicant may require a$37.00 deposit prior to ravlaw. <br /> 5• TENTATIVE appointnrontl dates must be confirmed with EHD staff. <br /> S• ApplFcat�riz received aftgr3.00 PFn Wilf be Processed the next business day. ' <br /> CONFIRMEDAPPOINTMENTDATE TIME <br /> DATE CONFIRMED . <br /> PHONE <br /> FAX <br /> I " INITIALSFAEV", ED YES NO REVIEW DATE <br /> Eh W u Feu mn <br /> TOTAL P.01 <br />