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DATE REGEN ED <br /> SAN JAPUIN COUNTYPUBLIC HEALTH S VICES <br /> IVIRONMENTAL HEALTH DIVISIO� (, <br /> K M✓ OVI/ I 304 EAST WEBER AVENUE,THIRD FLOOR <br /> / STOCKTON CA 95202 <br /> lllli�ii (209)468-3420 <br /> PUBLIC RECORDS <br /> APPLICAN Z . � RELEASE APP <br /> LICl�TA'Cn{TnJ ICO/-IN <br /> SUSIINESSfAGENCY ddWJ 606 <br /> ADDRESS 23 fnOadl- (�Lq ?5a; / <br /> PHONE AQ yb hnLQo <br /> FACSIMILE a09_ <br /> TENTATIVE'APPOINTMENT DATE TIME <br /> (Pleae gva 7 40 b. snumnittal) 4 2001 <br /> CHECK BOX TO EXPEDITE READ 78.00 PEE-REQ t PRO ESSE W 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Q <br /> FILE ADDRESS <br /> NP $ FGf'Yl 0 <br /> / )E48 7— t — -- — <br /> ryF sr nisi- r6 <br /> ri <br /> r <br /> NF S <br /> \I' J f r1gA `µ <br /> NG jt y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP 517E(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) R FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMFTTED FACILITY ❑ MOTEIJHOTEL ❑ PUMPER YRUCKlYARDfCHEM TOILETS <br /> ❑ TATOWBODYPEIRCING t7 POOU$PA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by Checking <br /> tate appropriate box(es). At least one rile type MUST be.selected. Fax to(209)464-0138 or mail to the <br /> address irldicated above. <br /> 2. EHD will notify the applicant if any EHD files exisL An appointment for review will be Confirmed <br /> approximately five 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 filghat Is actively being worked on by END staff may not be immediately available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the some condition as released will be reorganized by EHD staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a $78..00 deposit prior to review, <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD staff_ � C <br /> E. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> pJl W t4 01mLp0 <br />