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O9/e2/2003 07: 32 559265Z,�Z6 Twi ING LABS PAGE 01/0 <br /> 10-17-20(00 1 F 6V <br /> ! TO 15592I26 P.e2 <br /> n— �� slv JOAQuIM CO �HUCUc:NUM4kN <br /> UNTYPUBL C HEALTH SERVICES <br /> 17 <br /> ENVIRONMENTAL HE LTH.DIVISION <br /> SEP 0 2 2003 304 EAST WEBER AVENu ,THIRD FLOOR <br /> STOCKTON CA X242 <br /> ENVIRONMENT f�EAI_TN (zon) 468-34 o Zo�i- L[ �(-• ( �3 <br /> ---pE�MI3/SERVICES PUBLIC RECORDS RELE SE APPLICATION <br /> APPLICAXT <br /> s SllSINESSIAGENCY + <br /> _ <br /> ADDRESS '" % /7',-,--, ) 1 <br /> FACSIMILE <br /> TgNTATIVE'APPojmTmr;NT DAVE S TIME • <br /> (Prase Dive 7 t010 busiriess days from data of applizat;*n subatitta0 <br /> CHECK BOX TO EXP12D1TE RIrC�UE57-- PROCESSED �y ley-`iJ r <br /> _ S87 FEE-.R>;QtILST IN 3 BUSINESS DAYS <br /> SIGNATURE OF AAPLICAfVT �W FEE-R l �� <br /> c DATE <br /> FILE ADDRESS <br /> THIS SIDE EHO STAFF USE ONLY <br /> PROGRAM EL&MENTS SEARCH <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> C�UNCERGRQUND TANK(UST)CLEANUP SITE(LOP) ❑ HOU31NG ABATE FAIT 0 SOW WASTE FACILITY <br /> OTHER CLEANUP Silt(NON-LOP) ❑ 0040 FACILAY ❑ SOW WASTE VEHICLE <br /> LV\UN0RRGP.0;;N;TAN1S(moNITQR1tjafmr;mQVAL) Ci DOG KENNEL L] DAIRY <br /> CPV'IAZAR9QU6 WAM GENS ATOR Q CHICKEN WCH ❑ PKGTREAT.MENTPLANT <br /> ❑ TIERED PERMITTEE FACILITY © ii O T LIHOTEL 17 'PUMP411 TRUCKMARMCHEM TOILETS <br /> C TATTMOODY PEIRCIN(I © PdDl1SPA - " ' 0 I-AMD USE APPLICATION SnS <br /> G MEDICAL WA3TE PAOSATY 'Cl PUBLIC WATERS STEM 0 OTHER IKEASE SPECIFY ABOVE) � <br /> 1. List tip to tern addresses in the space above. Select the typ$(s) of fries from tho list above by checking <br /> the appropriate box(es). At teask one fife type MUST be selected_ Fa 209 A <br /> 0-01 <br /> wUl els iticl,� � 2bove, <br /> 34.9 r MIR 41 In 1b <br /> 2. EHO will notify the applicant if any EHD flies exist. An'appointment for review will 11e confirmed <br /> approximately ffve business days but no later than to (10)days after receipt of application.•The riles <br /> will be held for a maxlnnum of five business days for r view. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being vmrlted on by END staff ma not b♦immediately available for review. A new <br /> applicatlon may be subrrlitted when the file is avalla :1 . <br /> 4. Any flit not returned in the Sartre condition as release ',Will bo reorganized by EMD Std at the 9xpense <br /> of the apiiacant, Future file reviews by the Same appli �nt may require a $87.00 deposit prior to rowieuv. <br /> 5. 'TENTATIVE APPOintmerlt dates Must be confirmed wi h EHD staff. <br /> 6. Applications received aftet 3:00 pm will be processed he next buslnass day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PRONE FAX INITIALS _ <br /> VIEWED YES NO R IEW DATE <br /> u a�ror� <br /> 1 <br /> TUTPL P.02 <br /> I <br />