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s <br /> :Ucr�9cvcnen eiw icH:w..�nx ��6�J� <br /> SAN JOAQUIN COUNTYPUBr_IC HEALTH SERVICES <br /> ENVIRONMENTAL,HEAL:THDNISION <br /> 304 EAST WEBER AVENUE THIRD FLOOR <br /> STOCKTON CA 95292 <br /> (203)488-347A <br /> PUBLIC RECORDS RELEASE APPLICATION J �� <br /> APPLICANT 1 =4 Lj r-"le t I SUSINESI&ACENCY c2 1�L1[ <br /> ADDRESS 1'11y wrt a �} ..� tet. , CA �o� <br /> PnoKe $ �P1888 PacswLE S,32-- 93 <br /> TENTATIVE-APPOrNTl,1ENT OAT5 I0»16'00 TW= <br /> ::te�tt iPl4=..y;+o T to 10 otainoae day,from daft al appikallon aubmitw) <br /> CJ CHICK DOx To EXP OITE f1;"U ST- EE-RE PROCE"r;g IN ZU31 Y3 <br /> SIGNATURE CF APPLICANT DATE �D�yIA7 <br /> PL'!AhDRESS TMtS site ENU BTAFT USE ONLY <br /> PROGRAM£LENENTS&LIARCH <br /> e 1 <br /> ENVIRONMEi+TAL HEALTH DIVISION FUM <br /> e UNDERCROUND TANK(Ut)Q GLVOUP SiTC CLOP) G HOU32io AHATENENT M SOUDWASTE FACILITY <br /> VTHER C Z VvUP 51TP(NONLOP) C3 FOOD FACILITY 0 SOLID WAWM vEHIOI-E <br /> NDLR+RO::ND TANK tXONITORtN:JRUOVAL) C; DOG KENNEL a DAIRY <br /> C HAZARDOUS WAST£GFNBRATOR 6 CHICKEN RANCH O PK3 TFPAT7.LNT PLANT <br /> D TERED PFFJJ=eD FAC14M C MOTEL.'HOTEL II PUMPER TRUCK/YARDICHRU TOILETS <br /> C TATTO01eOTT1'PVRCIN3 In POOLi*PA 0 LL-ND USE APPUCAnON SITU <br /> C MEDICAL WASTe FACLiTY M PUBLIC WATER SYSTEM,, Cl OTHER(PLEASE SPECWY ADOVE) <br /> 1. _ist up to ken ed6re*5c*in the space above. Select the type(s)of f'les from the list above by ctteCX1.� <br /> the approprfata oox;ec). At least one Fie type MUST be selected. Fax to l202)ff�{-0138 or mail to the <br /> AddmM <br /> 2. EHD will notify the applicant if any EHD fq'er,exist. An appointment for review will be CGnrirmed <br /> approximatefyfive Duslness days but no later than ten(d 0) days after receipt Gf application. The files <br /> will be held for a maximum o:five businocc days for review. Appointments should be Scheduled <br /> accordingly. <br /> 3. A file that Is actively being wottied on by EHD staff may not be imu ediateiy available for review_ A mW <br /> application may be submitted when the file is availabla. <br /> 4- Any V12 net raturnad to the same condition oa released will be reorganized by EHD stair at the expanse <br /> of the applicant. Future flle reviews by the sarne appl-mmnt may require a Vi4,00 deposit prior to review. <br /> 5. 'TENTATfVE appoint nant date*must be confirmed with EHD staff, <br /> 8 Applicatlorr received atter 3:00 pm will ba processed the next baolncsa day. <br /> II CONFI' RMED APj'OffMAPh'T DATE T1 dE <br /> DATE CONr-IRMED PHONE FAX INiTTALS <br /> FEVIEWED YES NO REVIEW DATE <br /> tr N 19 Y✓3V91 <br /> TAT`Ife F.01 <br /> :d 'AdGc:SO OOPZ I10 'TOc £886 628 600 = 'LN 3NOHd STSFjV-y 0laZ punO.acd 140d-d <br />