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DATE REfEIVED ' <br /> 07 eE <br /> SAN JOf J1N COUNTYPUBLIC HEALTH ZVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EA T WEBER AVENUE, THI FL©OR <br /> }• ^t y STOCKTON CA 952021-l" $) <br /> (209) 468-3420 ' <br /> L. LIC RECORDS RELEASE APPLICATION <br /> APPLICANT tnpQi e_Z BUSINESSIAGENCY <br /> ADDRESS 1 V CJ S� <br /> n LL— <br /> PHONE- 1 L FACSIMILE 2� —OS5 AY M2 8 2002 <br /> LJ <br /> TENTATIVE*APPOINTMENT DATE ( )V1<�-- 02— TIME A,ft VIROWENl HEALTH <br /> (Please give 7 0 1 $mess s fro",o of Ycation su Mittal) PERMIT/SERVICES <br /> t • <br /> CHECK BOX TO EXPEDITE REQUES -$87.0 FEE EQUEST PROCESSEI�IN-�:??NES AYS <br /> SIGNATURE OF APPLICANT Q C DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> rnr <br /> /J <br /> A/ r d <br /> J In <br /> ri�,, <br /> dUN <br /> r cc.C' <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 5� SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> Cl TATTOOIBODY PEIRCING ❑ POOUSPA - ❑ LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY Cl PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) 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 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. 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 /> application may be submitted when the file is available. <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 $87.00 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br />