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DATE RUmveo <br /> EHDL-pG7M,MdB� <br /> SAN JUQUJN COUNTYPUBLIC HEALTH t.AVICES <br /> ENVIRONMENTAL HEALTH DIMION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR APR 112000 <br /> STOCKTON CA 85202 <br /> (249)468,3420 r NVIRONW EP.J­_ . :ALTH <br /> PUBLIC rRECORDS RELEASE APPLICATION ' : ,�1-:'Si uviC�� <br /> APPLICANT Cv! BUSINESSIAGENCY 'Fh <br /> ADDRESS � '/yx ,Ih <br /> J <br /> PHONE_42i/Q —1,0012 FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE . TIME <br /> (Please give 7 to 10 business days from date int applicatlon submittal) <br /> �GHECK BOX TO EXPEDrrE REQUE •$78.00 FEE-RE'QUEST ESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS 3CA <br /> 1 <br /> i <br /> l n_0 L v <br /> LFU <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK{U5T)CLEANUP SITE(LOP) 0 HOUSING ASALFEFAENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING)REMOVAL) LI DOG KEKNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PE=R11 rr5D FACILITY Q MOTEU140TEL ❑ PUMPER TRUCKIYARDfCHEM TOILETS <br /> 0 TAT roaiaoOY PEIRCING 0 PCOL1SPA C] LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE.FACILITY M PUBLIC WATER SYSTEM M OTHER(PLEASE SPECIFY ABOVE) <br /> t. List up to ton addresses In the space above. Select tate type(s) of files from the list above by cxlecking i <br /> the appropriate box(es). At least one file type MUST he Selected. FaZ to f209)464-0138 or mail to the <br /> Address indicated above. <br /> 2- END will notify the applicant if any EHD files exist An appointment for review wilt be confirmed I <br /> approximately five business days but no later than ten (10) days after receipt of application. The files <br /> wilt be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly, <br /> 3. A file that is actively being worked on by,EHD staff may not be immediately available for review. A new- <br /> application may be submitted when the file Is avallalble- <br /> 4. Any file not returned in the same condition as released will be reorganized by END staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a'$78.00 deposit prior to review. <br /> 5. 'TENTATIVF appointment dates must 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 /> Eli as 14 ntim3ma <br />