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OAQUIN COUNTYPUBLiC HEALTH S§IICES <br /> ENVIRONMENTN.HEALTH DIVISION <br /> APR 0 7 2003 304 EAST WEBER AVF_NUE,THIRDF40OR � O <br /> STOCKTON CA 85202 <br /> ENVIRONME (209)45&3420 <br /> Lib_'RECORDS RELEASE APPLICATION <br /> APPUCANT 2SU)a__(_72 C gUSIHESS/rA'G/ENCY S / OI o�1 <br /> ADDRESS�I L7—Lf�_. S�'•� 0 k IG(lt..►'��L/� <br /> 5-10 ' 7.7�� �� FACSIMILE I lG� S�iYSs <br /> TEWAT IVE'APF OIHTIMENT DATE 46 le _ TIME <br /> (Pits►*give T 10'10 hus{nOee d$y%from da"!Of application subml 1)h0/!f.5 " !�s{/!�T s44w.,�� <br /> -woe/d 11b I(V f✓eu s� <br /> C!rECK BOX 70 EXPLbrr1:RkQUEST-09.00 FEE-REQUEST FROCESSW IN 3 BUSINE33 DAYS <br /> SIGNATURE OFAPPLICANT _ DATE <br /> FILZ ADORES$ / PROOPM ELE.)AP? $EARCFI <br /> ENVIRONMENTAL HEALTH OIVISION FILES <br /> ❑ HOUSING ABATEMENT C3eQUD WASTE FAC1L" <br /> /O UNDERGROUND•TANK NaTI a)•yAtUP S1TE(Lop) p FOOD FACILRY 0 3OUD WASTE VEHICLI= <br /> t • OTNER CLEANUP Srrt=(NON-1-CP) Q DOG KENNEL 0 DAIRY <br /> J) O UNC)ERGROUND TANK(MGNITCRINGIRP-MC ❑ CHICKEN RANCF ❑ PKG�AT�EN7 PLANT <br /> p HAZXADOU9 VIAM-GENGPAT>R 0 CHICMorN RAN ❑ pULIpERTRUGK/YARD/CHEN TOILETS <br /> O T1elcao PERMrrTkD FAC1Lr1'/ 0 LAND USE APPL1CATION SITES <br /> D POOUSPA ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 0 TATT❑LBODY PBIRCISO cl <br /> n MEDICAL WASTE:I=ACILITY checking <br /> �. List LIP to ten ad,dtE,ssa+:In the space above. SeleCt the typ0(s)of(rtes from the list 13ov rbmail to th(3 <br /> the alopl•opriata lso]:(Q>t). At feast one file type MUST be selectaad. F <br /> addruat'I icax s!'bovt, <br /> 2 F.Hp wiGi notify the.applicant if any EHD files exist. An appointmont for review will be confirm <br /> ed <br /> approxIMAtply fl1re ":sIn*ss days but no later than tun('i 0)days iso nUytsntS shouldpt Of pbe scheduled <br /> f ices <br /> will be hold for a,m:axlmum of five business days for review. ApA <br /> accordingly. st2ff may <br /> now <br /> 3, A Elie that is aCtl'�ely being <br /> when the tUa D available.not be immediately available lot review. Anse. <br /> application may I cq submitted anisad by I?HD staff at the exp <br /> d any filo not <br /> returned d in the same Conditthe as rai IIPPI"nt may req <br /> Mira a�+SJ.DO daposlt prior to review• <br /> of the applicant. Futuro fie rvvlows by the same app <br /> t be onnTirmed wtth EHD staff• <br /> 6. <br /> Appl;wtions roc.eivsd Kfter 8:00 pm will be processed the next bualne>fs day. <br /> g 'TENT,4TIVE ppp)olatment dates mus <br /> 'I <br /> TIME <br /> CONFIRMED APPOINTMI`.NT.DA INIYiALS — <br /> PHOHL FAX <br /> DATE CONFIRVE D <br /> yIEWED <br /> YES NO FtEViEW DAVE <br /> S:d WIjS0:0I Z0 'ady ON Xdd <br /> WOad <br />