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f•Ktn'1 NOA Env i ronmenta l - PHONE NO. 209 369 4228 Dec. 03 2002 02:54Ph) P2 <br /> OAT E RECEIVED EHD BGG NumBER <br /> [J <br /> AQUIN COUNTYPUBLIC HEALTH ;S RVICES <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> DEC 0 3 2002 304 EAST WEBER AVENUE,THIRD FLOOR 0(0 <br /> STOCKTON CA 95202 ! <br /> � Pdd��?f)id�IEIVT FkEALTH (209)468-3420 I� <br /> P[-RIM IT/SFRVIGNBLIC RECORDS RELEASE APPLICATION <br /> 1 APPLICANT 441561 FkC-CO BUSINESSIAGENCY <br /> ADDRESS Z-Z- *D W; tTVN 1-01),I �,q <br /> { PHONU � 'r TTZO FACSIMILE (7,M) 34M <br /> j <br /> TENTATIVE*.APPOINTMENT DATE._-- �^� i x-"'QZ -_- -- Time 1 a•• O*V�. <br /> I` (Please give 7 to 10 business days from date of application' sub ittal � <br /> CHECK BOX TO EXPEDITE REQUEST.$89.00 FEE.-REQUEST PROCESSED IN 3 111 t Y r i l \: <br /> SIGNATURE OF APPLICANT DATE <br /> �� II <br /> FILE ADDRESS cjg2j+0 THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM E[.FMENTS SEARCH <br /> xq.�)•Gvi Avc• t '�°s N. Crui Id . :i °'. <br /> V/ IVLb is-}vi' <br /> 14 00 V <br /> lD� lZri <br /> E <br /> d Z N. C I J W Pv%,- !� <br /> '' i <br /> 133Jr• "1"'V1?14A.*- ted, , 1 0 �i 74 i<1 Il II <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 9UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 17 KousING AeATEmENT � O SOLID WASTIE FACILITY i <br /> 19L OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ TOG KENNEL ❑ DAIRY ' <br /> M HAZARDOUS WAST:GENERATOR ❑ CHICKEN RANCH k ;I O PKG TREATMENT PLANT <br /> ASO TIERED PERMITTED FACILITY d MOTEUHOTEL o PUMPER TRUCK/YARDICHEM TOILETS <br /> fJ TATTOOIBODY PEIRCING 0 POOLISPA I� 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 PUBLIC WINTER SYSTEM', ;��it OTHER(PLEASE SPECIFY ABOVE) <br /> I' II <br /> 1. List up to ten addresses in the space above. Select the types) of files from the fist above by checking <br /> tho 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 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 tiles <br /> will 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 in'ipmediately available for review. A new <br /> ' application may be submitted when the file is available. ,� <br /> 4. Any file not returned in the same condition as released wills be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applioant'may require a $89.00 deposit prior to review. <br /> I, S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day_ <br /> I� <br /> CONFIRMED APPOINTMENT DATE. . TIME ' <br /> DATE CONFIRMED ""PHONE FAX -INITIALS" <br /> �I REVIEWED VES NO REVIEW DATERte,.. <br />