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,FRChF-r�;'l : A Environmental PHONE N0. 209 369 4228 Tum. 1. J. 2E103 11:e5AM P2 <br />"D' D i,uc NUMBER JUIN COUNTYPUBLIC HEALTH .at.r,.VICEES <br />ENVIRONMENTAL HEALTH D1V1S11_)N <br />304 EAST WEBER AVENUE, THIRD I:1000 <br />JUN 1 -1 2003 <br />STOCKTON CA 95202 <br />ENVIRGi'�!f.�thJr NEALTN (209) 468.3420 <br />PFRU7, SEr;!; r PUBLIC RECORD, RELEASE APPLICATION <br />APPLICANT Z. tom! BUSINI?SSIAGSNCY <br />ADDRESS <br />TENTATIVE' APPOINTMENT DATE_ �` l 4, f 0 j3 TIME <br />(Pleases give 7 to 1Ubu%ine!s aysp from data ofappllca(ion submiti11) — <br />� I <br />Ey CHECK BOX TO EXPEDITE REQUEST 9.QQFEE - QI LEST PROCESSED IN 3 Bl1SINE;iS DAl' � I �3 <br />SIGNATURE OF APPLICANT DA1.1' <br />FILE ADDRESS THC> 31b� 7t)F STAFF USE ONLY <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />S, UNDERGROUND TANK (UST) (:LEANUP SITE (LOP) <br />X' <br />❑ HOt ISING ABATEMENT <br />Cl ; OLIO WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />Rf UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ FOOD FACILITY <br />❑ DOC: <br />S fill <br />WARM I <br />;;OLIO WASTE VI_HICU= <br />M. <br />■ <br />C1 <br />Cl <br />vAim, <br />F'KG 1REATMI-1917 PLANT <br />❑ TIERED PERMn"rED F=ACILITY <br />O MO'-EL/HOTEL <br />a <br />111mil I?R'1':a(ICKrYAR.CICHEet TOU.ETS <br />0 TATTOOIBODY PEIRCING <br />0 POOLISPA <br />C1 <br />I.AND'USI- A?PLICATION SrrES <br />z <br />❑ PUE LIC WATER SYSTEM <br />11 <br />()THE: Z (Pt -EASE SPECIFY AI30VI1) <br />. .. M <br />MOFP <br />II <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />S, UNDERGROUND TANK (UST) (:LEANUP SITE (LOP) <br />X' <br />❑ HOt ISING ABATEMENT <br />Cl ; OLIO WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />Rf UNDERGROUND TANK (MONITORING/REMOVAL) <br />❑ FOOD FACILITY <br />❑ DOC: <br />11 <br />;;OLIO WASTE VI_HICU= <br />❑ HAZARDOUS WASTE GENERATOR <br />KENNEL <br />O CHI ,KEN RANCH <br />C1 <br />Cl <br />vAim, <br />F'KG 1REATMI-1917 PLANT <br />❑ TIERED PERMn"rED F=ACILITY <br />O MO'-EL/HOTEL <br />C1 <br />111mil I?R'1':a(ICKrYAR.CICHEet TOU.ETS <br />0 TATTOOIBODY PEIRCING <br />0 POOLISPA <br />C1 <br />I.AND'USI- A?PLICATION SrrES <br />O MEDICAL WASTE FACILITY <br />❑ PUE LIC WATER SYSTEM <br />11 <br />()THE: Z (Pt -EASE SPECIFY AI30VI1) <br />w <br />w <br />1. List up to ten addresses in the space above. Select the type(s) of files fro n the list above by chf)eking <br />the appropriate box(es). At least one file type MUST be selected. Fax to109 464-0138 or mail to the <br />address indicated above. `� <br />2. EHD will notify the applicant if any EFID files exist. An appointment for rr riew will be confirmed <br />approximately five business days but no later than ten (10) days after receipt 01` application. Thi- files <br />will be held for a maximum of five busine� s days for review. Appo➢!itinen. s should be scheduled <br />accordingly. <br />3. A file that Is actively being worked on by iE°HD staff may not be Immediately available for review. A new <br />application may be submitted when the fill, Is available. <br />4. Any file not returned in the same condition as released will be reorganizad by E:FID staff at the expense <br />of the applicant. Future file reviews by thl! same applicant may require a!,89.00 deposil: prior to review. <br />5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br />G. Applications received after 3:00 pm will bo processed the next business day. <br />CONFIRMED APPOINTMENT DATE. TIME <br />DATE CONFIRMED <br />REVIEWED YES NO <br />.—mw- — <br />PHONE FAX <br />REVIEW DATE <br />INCI'1i11_5 <br />