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SAN iC LIIN COLINTYPUBLIC HEALTH SE► SES vv <br /> I IRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE.THIRD FLOOR <br /> STOCKI'ON CA 9$202 <br /> (209)468-3420 <br /> Pill LIC RECORDS RELEASE APPLICATION <br /> Ar'>'ucraKl 0 9LJ"ESSIAGENCY � <br /> ADDRESS o �iz Q <br /> PHONE FACsIFIILE <br /> .,1 ,o II:3o qm <br /> TENTATIVE'APPONTMENTDATE�(lai11G 63/DI)01 -'T0 �'L (' NM� eO& 4444hilf f7f <br /> (Picase give 7 to 70 business bays from CAte of appli.=ion suhmlttal) <br /> fin D/,L1 ,facJX,64. I <br /> CHECK BOX TO EXPEDCCE REQUEST-SE7.01)FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPUCAN � � DATE ©�0/ <br /> FI1E ADDRESSO <br /> THIS SIDE EHD STAFF USE ONLY. <br /> PROGRAht ELESIENTS SEARCH ' <br /> NFF W <br /> w s bo lioyc 1C4 <br /> {� n�a.0 feh �+ackaM p <br /> f � <br /> �F� honrE.2-130 r, RV if ty— <br /> AnT17 r <br /> ENVIRONMENTAL HEALTH DIVISIO FILES.Pi <br /> D <br /> UNDERGROUND TANK(UST)CLEANUP SCCE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP STYE(NON•-QP) ❑ FOOD FACKJTY ❑ SOL.II]WASTE VEHICLE ✓i <br /> 1�UnDERQt2oUna TANK(>VIONMOWNG/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> O HAZARDOUS WASTE GEIIERATOR ❑ CHICKEN RANCrI ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMI'ITED FACILITY 10 MOTEUHOTEL Q PUMPER TRUCXIYARWCHEM TOILETS <br /> D TATTOO190DY PEIRC)NG O POOLFSPA ' 4 LAND USE APPLICATRM SITES <br /> 0 MEDICAL WA3TE FACILrrY b PUBLIC WATER SYSTEM IJ OTHER(PLEASe-SPECIFYAROVE) <br /> 1_ List up to ten addre�es in the Space above. Select the type(s)of files from tho list above by checking <br /> the appropriate bores). At least one file type MUST be selected_ Fax to (209) +164-0138 or mall to the <br /> address Fndicatedjtbove. <br /> 2. END will notify the applicant if any EHD files eXist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days after receipt of applicatign. The fllaS <br /> wilf be held For a maximum of five business 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 immediately available for review. A new <br /> appIltation may be submitted when the file is avaFlable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> Of the apAllcant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 3. 'TENTATIVE appointment dates muSt be Confirmed with EHD s". <br /> 6. Applications received after 3;00 pm Will be prOCessed the next business day. <br /> CONFIRMED APPoiNTNIENT DATE TIME <br /> DATE CONFLgMED PHONE FAX INITIALS <br /> DL'Af1r:Wr!r1 l/CC wig OCIlICZwr rlA Yc' <br />