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FROM : NOR Envi ronlnenta I Pi�E]NNE NO. P I <br /> vaI=Ka�.JVhU : 209 369 4228 Dec. 23,2002 12:24PM P3 <br /> SANWAQUIN COUNTYPUBLIC HE_A �Holoas�„iaaEa <br /> ENV LTHERVICES � <br /> ENVIRONMENTAL HEALTH;DIVISION } <br /> 304 EAST WEBER AVENUE,THIRD FL60R ' <br /> DEC 2 2002 STOCKTON CA 95202' <br /> (209)488-34 <br /> 20 loqtr <br /> J?i! UBLIC RECORDS RELEASE h APPLICATION <br /> APPLICANT�_>~%C <br /> BUSINESSIAGENCY (/i rc�i ti►•t.� 4,AJ <br /> ADDRESS -ZZ 5 w <br /> 5Z 416 <br /> PHONE 0S FACSI1MiLE X09 3 `'!�f—yZ2$ <br /> TENTATIVE'APPOINTMENT DATELDS ry._TIMI", g-ae ` 3 7 s <br /> (please plus 7 told business days from date of—8' <br /> hpllcation submittal) <br /> s � <br /> CHECK 80K TO EXPEDITEREQUEST.S E_RE TP OCESSED IN 3 BUSINESS DAYS un <br /> I <br /> SIGNATURE OF APPLICANT � <br /> DATE <br /> FILE ADORES9 II Ih <br />! j THIS SIDE VMD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> I $$b is fb r k .. l.od: CA <br /> j A gpo y ' -for • Nn p I` <br /> 5 II <br /> G <br /> 5 L CR <br /> I .II tiEtS, <br /> ENVIRONMENTAL.HEALTH 0111SION FILES <br /> 19 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT © SOLID WASTE FACILITY <br /> m'OTHER CLEANUP SCrE(NON-Lop) ❑ FOOD FACILITY J Q SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONIiORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> Ar HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERmn' %3 FACILITY ❑ MOTELIN <br /> OTEL D PUMPE <br /> R TRUCKIYARDICHEM TOILETS <br /> d TATTOO/aODY PEIRCING CI <br /> POOL/SPA 'I C3 L/wo USE A01JLICA1710iU Sri'!=s <br /> 0 MEDICAL WASTE FACILrTY s ❑ PUBLIC WATER SYSTEM >` PW OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types) of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be sele d#ed. Fax to 208 484-0138 or mail to the � <br /> address indicated above. <br /> 2. EHD will riot€fy tho'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 application. The files <br /> will be held for a maximum of five business days for review.1�Appointments should be scheduled <br /> accordingly. I <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available, j 1 <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review, <br /> 5. 'TENTATIVE appointrnent.dates must be confirmed with EHI6 Staff.!l } <br /> 6. Applications received after 3:00 pm willbe processed the nett business day. <br /> CONFIRMED APPOINTMENT DATE. � I <br /> TI .. ..� F <br /> DATE CONI=IRIVIED .,PHONE FAX :INITIALS <br /> REVIEWED YES NO RMEW DATE <br /> I ,Ij <br />