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02--15" FROM TO 19252436663 P.02 <br /> —j � �' ' PUSLIC HEALTH SER <br /> EN VIRONMENTAL HEALTH DIVISION VICES (Del <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> AUG 0 5 2004 STOCKTON CA 95202 <br /> 6VViR' NMENT HEALTH (209) <br /> EAT THPUBUCG RECORDS 9RELEASE APPLICATION <br /> AL'��:..\'" OustNES51AGENCY��KY$-SPL}✓� c <br /> FACSIMI'LE <br /> IV / <br /> TENTATE'APPOINTMENT DlATE�� A2 Y _ T,me U t <br /> rLl <br /> ,---�lyyyl ,t•1 r ` • (Please Uwe 7 br�10 bu.Incss Eay_Ira+ date of application aabmilltlll � <br /> / y' �_ 4 V / <br /> Q.iXFE3ITr REQUEST. FEE_ U"T CESS D W 313USINCSS DAYS 5 <br /> si'axA:7" RE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE pEL STAFF WE ONLY <br /> PROEL <br /> GRAM EMENTS SEARCH <br /> La <br /> ~ ENVIRONMENTAL HEALTH DIVISION !=ICES F jJ <br /> �:- <br /> UNOE Gr OUND TANK(UST)CLEANVP SiTC(LOP) 0 HOUSING A13ATFMENT O 501.1A W�r ltrT1' <br /> OTHER CLEANUP 517E(NON�OF) ❑ FOOD FACILITY In SOLID WASTE VEHICLE <br /> JN]L• GROUNA TANK"tMONRORINWREMOVAL) 0 DOG KENNEL t] DAIRY <br /> vihFTS GENERATOR O CHICKEN RANCH O PK4 TREATMENT PLANT <br /> FAC71„ITY D MOTEVf10TEL O PUIIKA TRIICIUYARDlCHEM TOILETS <br /> . I7 POOL PA "' O LAND USE APPLICATIONSIT15S <br /> .: �'�:'A:_w'AST> XACrLiTY D PUMUCWATER3YS.TEM O OTHER(PULASESPECiFY ASOVL-T <br /> i <br /> UxT up to ten addresses in:th@ space above. Select the type(s)of files from the list above by eheelting <br /> tfie appropriate box(es). At Idast one file type MUST be selected. Fax to (209)464-0135 or mail to the <br /> ^dress indicated above. <br /> • ": o5fy the applicant If any EHD files exist. An appointment for review will be confirmed <br /> -^eroxirtgtely five business days but no tater than tbn(10)days after receipt of application.-The riles <br /> j will be held for a maximum;of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> ! A file that Is actively being Worked on by EHO staff may not ba immediately available for review. A new <br /> z. plication may be submilttiud when the file is available, <br /> A-.y "11c not rotumad in thatsame condition as released will be reorganized by EHD staff at the expense <br /> ^: appi car.L. Future fila reviews by the same applicant may require a$97.00 deposit prior to review. <br /> 'TENTATIVE appointment 4ates must be confirmed with EHD staff. <br /> 5. Applications received aft03:00 pm will be processed the next business day. f ` i <br /> ?POINTMENT DATI TIME <br /> I DATE CJ},'NFIRMED - PHONE FAX INITIALS <br /> YES NO 3tt:vrFnnrnnro TOTRL P.02 <br />