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r�af6 Q6C�+JY[O - � L-rii U.hi Kt}i�:+i-7t <br /> SAN „"!.�AQUIN COUNTYPUBL110 HEALTH -WICES <br /> HEALTHENVIRONMENTAL Iv <br /> ISION <br /> 304 EAST WE ER AVENUE,THIRDFLOOR <br /> STOCKTON CA 957-02 <br /> (209)458-3420 <br /> PUBLICRECORDSRELEASE APPLICATION <br /> APPLICANTr� �'//G`rf�rr Hu51NE�SSlAQE7tCY G �./t�i��7z�/ �'' -�g�-P _ <br /> ADDRESS ] (�rS�i S�l7rS'l fJr .t/ +�l r'-��1 f��'t�-L ��.•�'�`/ <br /> PRONE L� �c3 FACSIMILE-A � . <br /> TENTATIVE"APP+D/I+[ MIMT DATE 'nME <br /> �—q (pleas4 give 7 to 50����daYs frim--3 <br /> ,f a�flPlicavan swami � y <br /> lJ (0 F ST PR'OSIC'ESSED V 3 BUSINESS om ILE - <br /> P y <br /> GHECK BOX:' 6=7CP>=BITE REQUEST 57$.00 FEE- REQUE <br /> SIGNATURE OF APPLICANT DATE <br /> FILEADDRESS <br /> /$7 <br /> _ -q <br /> S <br /> -04 d7 <br /> ENVIRONMENTAL HEALTH DIVISION FILES 2, <br /> 6 <br /> UNDERGROUND TANK(UST)CLEANUP SrM(LOP) 0 HOUSING AnATEMeaSCUD WASTE FACILITY fA 5;4'C <br /> OTHER CLEANUP SITE(HON-LOP) 0 FOOD FACMATY SOLID WASTE VEitCLE G <br /> UNDERGROUND TANK(MON1TORJXOffWMVAL) O OOG KENNEL O DAIRYS VJ :5 S K- <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG-M ATMENT PL ANT L <br /> L7 Y]EPMD PERMITT60 FACILITY o Mo-raMOTEL PUMPER TRUCWYARDIGHEM TOILe 3 s'c^- <br /> 0TATT401$QDT PEIRCING CI POOLMPA LAND USE AAPUCATION SITES +0MEMCA.L VYAVM FAOUTY ❑ PUBLIC WATER SYSTEM OTHER(PLEA56 SPECIFY ABOVE) <br /> J E <br /> KI Li*t up to ton addres�es in the space above. Select the type(s)of files fro Ist aW� ecking �CA�/` <br /> the appropriate box(t.S). At least one file type MUST be selected_ Fax09 4_1,64-0138 orsi ail to th_c � L <br /> addre§indleated above <br /> 2. EHO will notify the appilcant if any EHD fibs exist. An appointment for review will be confirmed <br /> ApPrOxlmately give business days but no later than ten(10)days after receipt of application. The files <br /> Will 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 i5 available. <br /> 4. Any file not returned in the same condition a$released will be reorganized by EHD soff at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a S7a_00 deposit prior to review, <br /> 5. `TENTATIVEappointtnent Gates must be connrMed with EHD Staff. <br /> 6_ Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMS-0 APPOINTMENT DATE TIME _ <br /> DATE CONFIRMED PHONE FAX INMALS <br /> ` <br /> RF-VIEWED YES NO REVIEW DATE i <br /> F-"IPV +• ovasrpu i <br /> TUTaL P.02 <br />