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ipperru---Phas_ EnvinDnmental Inc- FHX h:U. 2b=)_- 9UL''�)_5 _ i b_ �,�, 'LUb1 <br /> 1`'= SAN J UIN COUNTYPUBLIC HF-ALTH SERVICE: <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR 76 <br /> 76. STOCKTON CA 95202 <br /> (209)468-3420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT /� <br /> rBUSINESSIAGENCY {�'�0" �HA.� �l!/IP�JCIJt'IiUlfjr�}(., //VG, <br /> ADDRESS -1-37/Cy -,JAwkJ Avi �t� 'Z�f� r�� {7p1��-��7-^Cy e49t r—ff� <br /> PHONE ��� �r*J L,.5�:�? ,.__....FACSIMILC 0?V / ._ 7��. 4 2�q <br /> TENTATIVE"APPOINTMENT DATr TIME <br /> (PJe�se YP? <br /> l0 7pWuslnessda s Irotxt dtapplicationsvtrmiUal) <br /> GHECIC80XTOEXPEDITE REQUEST REQUL•ST PROGES D IN+/I3USINESS DAYS <br /> SIGNATURE OF rZPPLICANT DATE S Jp j <br /> FILE A13DJz1n5s7Ht5 S1D2 CJiD STAFr•43E ONLY <br /> PROGRAM F_r>E1iIEXT.S5LARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UND]SaRGROUt+ID TANK(UST)CLEAMUP SITE ILOP) Cl HOUSING AJDATEMENT Q saLID WASTE J aCiLiTY <br /> OTHER CLCWiUP SITS(Noes-LQP) Q FOOD�A;rlLrrY (� <br /> $f UNDERGROUND TANK(MONITONNWRC140YAL) O DOG KENNEL 0 DAIRD YYAS7C VEHICLE <br /> HAZA R13 OUS WAZ3E G04ERATOR 0 CHICKEN RANCH 0 PKGTREATME.NTPLAttT <br /> TI ERECT PERMITT§0 FACILITY C3 MOTl LIHOTEL TOILETS <br /> M H <br /> ofC <br /> a PUA7PEJZ 3 FCUCKIYARET <br /> 0 TATT00180pY pljIRC;NG L7 POOUSPA C3 LAND USEAPYLICADICTION ET <br /> a MEDICAL YYASTE`FACELTY 4 PUBLIC WATER SYSTEM d OTHCR(PLEASE SPECIFY AripVE) <br /> 1• fast up to ton addresses in tile space above. SojDct tho,type{s) of fii¢s from the tisk aboYe by chcckiI1rJ <br /> the appropriate boX(es). At foast one filo type MUST be selected. Fax to 209 464-0'138 r <br /> a dr 55 i � o mail to t <br /> nil aced abQue ho <br /> 2. CHD will notify the applicant if any EHD files cxist. An appalntmet�t for review will be confirmed <br /> approximately five business days l7ut no Jatcr than tbn (10) days after receipt of application, The fibs <br /> will be held for a maximtln�of five l,usine.ss days for review, Appointments should bOrSChodu1 <br /> accarditlgl � ed <br /> 3. <br /> Y <br /> A file that <br /> 15 d(;ti <br /> Ycly being worked on b <br /> application y le 16 staff may not be imrnediat <br /> ratio cl v . <br /> Pp n available m a Mabl e <br /> 4. y be submitted when tht:file is availalsic, � for rcvJcw. .q rJc� <br /> p`n3r Ella not ratv�wtiCd in Zhu same condition aS released will ba reorganized by E'HD staff at tlto expense <br /> of the applicant. Future file revlew5 by the Same applicant may require a$87.00 deposit prier to pease. <br /> 5- `TEN-NATIVE appointmor)t bates must be confirmed with EHD s <br /> Ji. �4pplicatians r teff <br /> eceEved after 3.00 pm will be procosscd the next bu31ne33 day, <br /> t <br /> CONFIRMED APPOIKTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> j PHONE FAX INITIALS <br /> LREVIESr ED .'� <br /> i YES N <br /> pFUTJ'1h!rta�•� <br />