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X11 _.,1 00OAQUIN COUNTYPUSLIC HEALTH S!= " ICES <br /> "� ]ENVIRONMENTAL HEALTH DIVISI <br /> APR 0 7 2003 304 EAST INESER AVE=NUE,THIRD FLOOR <br /> STOCKTON CA 15702 <br /> ix09)4W3as0 <br /> CNVIR{�NME F T�I��RECORDS RELEASE APPLICATION <br /> �APPLICANT f" L� ..-sem?I` IuSIHESS/Aar'NCY <br /> APDRESS—1�? <br /> * NONE X 10 � 14s'� 5;7 r� ,!r' FAC31MILE f g 1A43 n <br /> �� <br /> TENTATIVE'APf OII+.TVIENT DATE_ a 5 spm � r jtnur5 sr �/r'� <br /> (p;et►a plus T to t0 hvsjno�s from Bate of applirxttort suiami 1) s <br /> IlAe A- <br /> L�.,olccc{ �euie� <br /> CN>±GK UQX TC,,EK%,bTTl: REQUr. r-><J39.60 FE>:-i r -FT FROCF-S3=0 IN 3 8 SINr3a DAYS i�5w�c J��+V w S Gr.c t[z(4,�i <br /> BATE •�5-��" 7C��f <br /> 'SIGN1�TUfZE <br /> 01--APPLICANT _ ^�. - -- - 7 <br /> sfb a s r+i <br /> FiLr�ADDKES3 PRC34RAbA 6LEI11ENTs SfJ�G1K <br /> ENVIRONMENTAL HEALTH DIVISION PILES <br /> y}pU53NG ASATI!MEN7 CIUQUD WASTF isACtLrrY <br /> O UNDERGRouND TANK NSri tX�NUP&ll'!:(LOP} 0 FOOD FACILITY a saUD WABTt?YEHtCLE <br /> ❑ OTHER CLEANUP 5fM Mcav-LCPi p DOQ ONNEL 0 DAIRY <br /> rJ UNDERGROUND'LANK(MCNIT'CRJNG1REMOVPl.} a C IICKEN F14NCH Cl PUM ER TFzWEN7 PLANTDn <br /> ❑ HALAXDOU3 VlASTI=GENWiATOR M07 t!}iO7EL ❑ PUMPER TRUGfUfAAD1CHEN TOILETS <br /> �, C) TIQ�1rEt)PEFzMrr7kD fACILrVe ❑ LAND U81=AP>•1.IC1tTICW 517ES <br /> [7 POOUSPA ❑ pYIIER pLEABIo SPECIFY AAOVE) <br /> ❑ TATTOOISODY PEIRCINCI C <br /> CS MEDICAL WASTE IsACILITY <br /> he 13 r mall to the <br /> 1, List Lip to ten�,d�3rE.stes in t caaiorie file type MU$Ttba s%ct1��files from the list ebov¢IaY chat Ing <br /> the a 0igapriata��o}:(QG). At t <br /> addr4,s3'i ica1 !¢J&O1`4. <br /> g F.HD wiE;notify fila:aped <br /> plicant If any EHD tiles exist. lS r1 appointmont for rQviaw will be confirm <br /> ;In ton(10)days after reocipt Of <br /> appruxi¢nately it+aq busi"*days but bu no dalxtgr tys for revisw- AppolnttrientS Should bit cheduled pplication. The f lies <br /> will be t•�eld for ai maxicn <br /> aCGordiagly. EHD Stoff mey riot bo immediately avallsble for review. Anew <br /> 3. A file that is 3Ctl-rely being w0rk9d on is Y <br /> applic�liiorl may by submitted when the Elie ie available. anix4d by t;Kp staff at the expense. <br /> 4. Any fil a not retumod in the same Condition as roloasad will be rcorg iprior to review, <br /> of the applicanL Futuro file reviews by tho xama epplc n may requite a$89A0 deposit <br /> $ 'Ti=t�TATIVi=S11),wintment dates must be confirmed with E>•O st0f- <br /> 6. <br /> vc t:eivod altar 8:00 pm will be processed the next buxinags day. <br /> gppl aabans <br /> TIME <br /> CONFIRMED ApPOINTMENT.DATF <br /> PHONE FAXINITIALS <br /> DATE CONFIRVE D ,.�_._ <br /> �"tJIEWED �_' <br /> YES <br /> NO RRVi EW 0 TE <br /> Ed WIJS0:0ti i=Fl(37 L0 --Ld'd 'ON Xtid <br /> WOW <br />