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� R 17-2003 15:35 FROM: :• - TO.r 10138 P.430r%002 <br /> 08/28!2002 15:05 46401x8 ENV1R0NMF�AL. I-E I'A�aE �a <br /> n"IMMo + ,SAN ,IOAf U1N COUNT1lE''l SLIC NF-Al-TH SERVICES ! . <br /> N E- 'E',fi 'I I�1 . ENVIRONMENTAL HEALTH DIVISIQN , <br /> 304 EAS•W_Br:R AV1-NUE THIRD FLOOR <br /> STOOKTON CA 95209 <br /> (209)408-3420 <br /> MAR 1 7 Z003 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> ' ,'.�_ riLt8tNE1ArENCY 'ps <br /> APPLIC <br /> ADDRF96. <br /> PHONE <br /> TIME <br /> TENTATIVE"APPO1NTk UNT DATE ; 44 <br /> (Pb,rllr plrb 7 to i 0 tauslM>�dgyc ft m do"of spplloaklan eut�tlUal) ��rd,3� , <br /> r <br /> CHFcx ROX To XEDTM ItF $8lS1N0 pAl' <br /> Q1EST- 9.04PEg RPP <br /> 0 AT E Z4 <br /> SIGNATURE;QF APPLICANT <br /> Fill AUDRI355 —T-H-1 SIDE•9Nq S /�P 18 DN4 .... <br /> t°R �QORgjXf4EHT5 51rARCN <br /> JA f4 <br /> ]ENVIRONMENTAL HEALTH DIVISION ril-EG <br /> 4. HATEMENT 130IJD WASTE FAGIL.ITY <br /> uNt�ERcil.OUNQ TANK(USTI CLSAl1WP srTE(I.OPI C1 HOUSING I4C1 FOOD FACILITY ' Cil Iia WASTE VIEHICI.E <br /> OTHER 0L W4UP SITE(NON-LOP) G poo KENNEL D DAIIIRY , <br /> UN13FRGRQUNO TANK(MONITORMiRF-MOVAL.) D CRICK RAl1cFl � PKI TREAMI°rrrPLANT <br /> HAZARnous wASTI:OE1 rRATOR C M07SL.WjML GJ I�UI� 'EfI T1tl7t:YWATION VM Tfllt-�itS <br /> TIM9EQ PCRI/R1•E0 FACri.ITY p PO{?L191PA Id LAND U$Z AP'PI.ICATION SITiLS <br /> TA-FTWIHODY PEIRCINt SYSTEM oThiER p0811 OPECIFY AHOV <br /> NMCAI.WA9r6 FACILITY p0" NTF) <br /> a s of files from th�Ea-t04bov rby it e,�� <br /> List up to ton addressOV In the eGM Mg <br /> peoe abava, 'UBTtba I4Cted. ,.L2 <br /> the appropriate box(esl<); At least ane Elle typo M <br /> dd jis 1MBatabg&— confirmod <br /> �. pili}will notify the app}icaas If syE M njois Iat9r exist. <br /> An t n ppi days nt for re llp�txb`�a;pp��at(o.Th+a#figs <br /> approximately five busfl� Y ater receipt <br /> t'Ofsilcl 13 11 scheduled <br /> will be hold for a maxir tlyn of five bus:InM days fpr revlow. App <br /> 21oco�di nDly. <br /> g, A file that is sctiv '' orkeo np by EHQ staff maY not b4 innme+ Oltsely a railatil�l far reu(ew. fi now <br /> sly being <br /> appllcation may be au (tI*d when the file Is available: <br /> 4. Any file not returned ir�'the same condition sols relemd Will be roargani; ld by fci�li]setoff 3t the pxp+ n� <br /> of the applicant. Putu#q file reviews icy the aame applicant mqy require a$x9.00 deposit prior to review. <br /> s, *TENTATIVE appaintlflent dates must be confirmed with EHP staff. <br /> .6, Applications recoived after 3:00 pm will 110 pracassed'the next business day. <br /> CONFIRMED Appo1NTMENT t)AT£. TIME w ' <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> FZWIEWED YES NO REVIEW DAT <br /> i' <br />