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IK" NOA Environmenia1 PHONE NO. : 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> WE RECENEb <br /> :'. EHD SOC NUMBER <br /> .i AQUIN COUNTYPUBLIC HEALTHWRVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> DECO 3 ZOOZ 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> STOCKTON CA 95202 1065 <br /> i ravrUcvlNMENT HFALTH (209)468.3420 <br /> FRIM+TlSFRviGK)BLIC RECORDS RELEASE APPS ICATION <br /> ff° APPLICANT �1GG0. 13USINESSIAGENCY aJa F_NVIPDNiMV_NTA1_ <br /> 11 ADDRESS) 2 4FD u%Tv j 1.r NJ 1-001 � <br /> r PHONE l � FACSIMILE (UM) 34; r`4Za"R <br /> TENTATIVE"APPOINTMENT DATE Imo-" 12--62- TIME 10, 6V AV{1 <br /> (Pleats give 7 to 10 business dayis frons date Cf application submittal <br /> M �r� �a`�� a�d � <br /> ' CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE.-REQUEST PROCESSED IN'3 I YS 2 <br /> + Ck �y� <br /> ' SIGNATURF OF APPLICANT D,ekTE <br /> F -G <br /> FILE ADDRESS THIS SIPE EHP STAFF USC ONLY <br /> j-,ROt3RAM E:I..EMENTS SEARCH <br /> ! c.vnaa W <br /> E <br />' la <br /> D <br /> Up We'Aw. T1 E <br /> as . <br /> t y�1 <br /> 07- Al. AVL V_ j <br /> VVI <br /> { �•� <br /> 133 E'. TV✓v1�w �, ► .. i..l ��. ' �7�-�t: �� � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9,UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> % OTHER CLEANUP SITE(NON-LOP) m ❑ FOOD FACILTTY 10 SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) EI DOG KENNEL ❑ DAIRY - <br /> 10 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> >FO TIERED PERMITTED FACILITY b MOTELIHOTEL Ct PUMPER TRUCKJYARD/CHEM TOILETS ' <br /> TATTOOIBODY PEIRCING 0 POOLISPA C7 LAND USE APPLICATION SITES <br /> C3 MEDICAL WASTE FACILITY 13 PUBLIC WATER SYSTEM 19 OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate bOX(es). At least one file type MUST be selected. 'Fax to 209 464.0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD tiles 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 revlew Appointments should be scheduled ; <br /> accordingly. ; <br /> 3. A file that Is actively being worked on by SHO staff may not'be immediately available for review. A new <br /> application maybe submitted wham the file Is available. z.i <br /> 4. Any fila 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 appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> l <br /> CONFIRMED APPOINTMENT DATe. TI'm E I <br /> DATE CONFIRMED .-PHONE FAX -INITIALS <br /> REVIEWED YES NO REVIEW lPATE:; <br /> �F <br />