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hYI,.Y J <br /> SAN JOENVIRONME TAI, HEALTH DIVISION VICE <br /> FEB 2 6 2001 304 EAST WEBER AVENUE,Tk"RD FLOOR <br /> STOCKTON CA 95202 <br /> E�!VI",!ial'id1�Pi`i H`�ALTH <br /> (2091468.34211 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> gUS(NESSJAGENCY �" F� � <br /> APPLICANT �1e ^Ari <br /> r Vj C q� <br /> ADDRESS <br /> 5•ID qZO —U-$4 FACSIMILE <br /> PHONE `t L� TIME 1 <br /> TENTATIVE'APPOtNTMEHT gnTE,,.,T Y <br /> CD <br /> �l (itiltonsubnritt>q <br /> (PI>ax 9ivo 7 to tD huslnau data hoT dale of>pP -a <br /> CHECK BOX TO EJCPen'TE REQUEST•LaT• FEE <br /> /-//RJ£�QUEST PROCESSED IN 1 BUSINESS DAYSDATE J/z� <br /> SIGNATURE OF APPLICANT I '�'---- f <br /> ,HIS SIDE EHD STAFF USE ONLY <br /> FILE 0.DDRESS PROGRAM ELEMENTS SEARCH �. <br /> .2953 35x91 aS ,o_ . <br /> 1.. Dl We { Lq 3527 `— <br /> r• <br /> tz tF ve. 3Sa fa <br /> a y k� 3Sz% <br /> & Z <br /> I .SI r S au [VISI' LE S Vl <br /> y� Q � ENVIRONMENTAL HEALTH IIlI510N FILfS I <br /> A'7 ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> C UP SITE(LOP) O FOOD FACILITY CI SOLID WASTE VEHICLE <br /> .)4UHp6RCR0UND TANK(UST) •LAN O DAIRY <br /> 0 OTHER CLEANUP SITE(NON-L011 E, DOG tIaNNEL 01PKG TREATMENT PLANT <br /> ❑ UNDERGROUNDTANK(h10NITORiNGfREMO'�AU O CHICKEN RANCH ❑ FUMpER TRUCKIYARDICNEfd TOILETS <br /> ❑ HgZARDOU9 WASTE GENERATOR p MOT6uNOT&L n LAND USE APPLICATION SITES <br /> ❑ TIERED PERMITTED FACIUTY M POOUSPA ❑ OTHER(PLEASP SPECIFY ABOVE) <br /> L] TATTOOMODY PEIRGING C) PUBUC WATER SYSTEM <br /> 0 MEDICAL WASTE FACILITY <br /> ' ace above. Select the typa(s)of fileS from the list above by checking <br /> x to Q 464-013H DL mail to <br /> 1 List up to ten addresses in the! one Elie type MUST be selected. ._{_?_.$� <br /> the appropriate boxes}. <br /> At least <br /> address(ndtca[e Vewill be <br /> confirmed <br /> files <br /> aHD Wilm atItyfive business days but no later than tan (10)days after receipt of application. <br /> 2 EHD will notify the epphcant if any EHD files exist. An x10)days afterre„�t of should scheduled <br /> ely will be held for a maximum of five business days for review. APP <br /> accordingly• <br /> 3 A fila that actively boii?9 worked on by EHD staff m <br /> at fs ay not be immediately available for review. new <br /> expense <br /> application may be submitted when the file)c available. at th <br /> 4 Any file not recur Future haler me co dationy ttm same appreleased <br /> cant may re4uirc A $87.0 deposf it priorto review. <br /> of me app <br /> g, •TENTATIVE appointment dataa mwb p�nracessedlthe not business day. <br /> g. Applications received after 3:00 p p <br /> I <br /> TIME <br /> CONFIRMED APPOINTMENT DATE -------- INITIALS <br /> FAX <br /> ` DAT[CONFIRMED PHONE FA - <br /> YES NO REVIEW DATC <br /> REVIEWED TOTrL P.02 <br />