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AN.R 0� 2003(MON) 1Q :13 flPOAT CENTRAL P. H"/M <br /> Rx Date/Time APR-01-2003(10N) 09 :48 Q640138 P. 002 <br /> 04/07/2003 10:15 4640136 ENVIRONMENTAL HEALTH PAGE 01 <br /> MTE RECZN r,(' EHd L06 N�YalR <br /> J�JOAQUIN COUNT''fPUBL10 HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> APR 0 7 2003 304 EAST WEBEKTON CAl95ZO2THIRD FLOOR I 17 1 <br /> STOCKTON CA95Z02 <br /> ENV'IRONMENTH( LTrI (209)468.3420 <br /> PFR�4iTiSERVIY LIC RECORDS RELEASE APPLICATIOIM <br /> APPLICANT La uJ S 7 I�AW zlxl BUSINIISSIAOFNCY �D/7(-<JT <br /> Olt"s S /h, 11)L k)-rd h' �p. S j-2,)G/C ,r�/'0 <br /> J AD ,1� C,./��• <br /> I-PHONE V(e-n3 j FACSIMILE t �d-7Y�3 Q .- <br /> TENTATIVE'APPOINTMENT DATE O TIME <br /> (Please Give 7 to ID busirleim days Rem data of appllcaaod submilGd) VA <br /> El CHECK BOX TO EXPEDITE REQUEST--$". 0 FEE-REQUES�ROCES;P0 IN 3 BUSINESS DAYS t� 'f G <br /> *SIGNATURE OF APPLICANT / -_/ Q fn N7/�' DATE y///7 03 f k t1 N <br /> �Y <br /> THIS SIDE EHD-STAFF LI:iE ONLY \� <br /> FILE ADDRESS PROGRAM ELEMENTS SEARCH <br /> s AW Gr , GCc rdl <br /> IIL <br /> ENVIRONMENTAL HEALTH DIVISION FILES ��_v� k r�•y:y{�'mh'`� h/ lA <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATIWENT 0 50LID WASTE FAUII LE <br /> OTHER CLEANUP SITE INON-.OP) O n <br /> FOOD FACG. Y G SOLID WASTE VVI11 LE {� <br /> ❑ UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DA1F:Y A �ST 61 I K' ` '�' 'HJ <br /> ❑ HA2AROOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PK6 TR.EAT6IEN'f PLANT p,,�p,,c{r�/i�II�J�'1 TOIL <br /> ❑ TIERED PERmnTED FACILITY ❑ MOTEUHOTEL O PUMPEn TRUCIVYARDII;HBM TOILEtSh•,h eV�.J <br /> ❑ TATTOO1000Y PEIRCING O pOOVSPA ❑ LAND USE APPLICATION SITES (QX�G r� I f f- <br /> G MEDICAL WASTE FACILITY ❑ M ❑ OTHER IPLEASE SPECIFY ABOVE) <br /> h,(ki l z' <br /> 1. List Up to ten addresses in the space above. Select the type(s) of files frim the list;above by <br /> the appropriate box(es). At least one file type MUST be selected, Fax to.(7119)464 0138 Or mail to e q <br /> address lndlcated above, it, <br /> Z. END will notify the applicant If any EHD files exist. An appointment for ravinw will be confirmed <br /> approximately five business days but no later than ten(10) days after rereil3t of application. The fi s <br /> will be held for a maximum of five busing"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 immediatery•availatlle for review. Anew <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD,siaff p the exp nee <br /> of the applicant. Futurofile reviews by the same applicant may require I1$39.00 deposit prior to r few. <br /> 5. 'TEDITATNE appointment dates must bo confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> F <br /> NFIRMED APPOINTMENT DATE TIME -- <br /> PHONE FAX INITIALS , <br />