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03/26/2003 11:37 2094671118 AGE STOCKTON PAGE ell/01 <br /> j F <br /> DATE RECEIVV?.� - ---- —f 1 -1 r4 <br /> AHD LOG umst:r; <br /> R$vAQIJIN COUNTYPU13LIC HEALTH L.,:610ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 2 6 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> 194F <br /> ,h"�/SF-P111N13L1C RECORDS RELEASE APPLICATION, <br /> APPLICANTN BUSINESSIAGENCY Gd 12 <br /> ADDRESS—R..3? , SAAt. ) 416 a eig 252,1�r <br /> PHONE C�Dq) 9&r7- �iX 10 FACSIMILE n_1 M X olv!h <br /> TENTATIVE'APPOINTMV-NT DATE C)-b TIME _ ,k __ 3s ) <br /> (Pleaso give 1, <br /> j to 16 business days from date of application submittal) <br /> 'jt(CCHECK BOX TO EXPEDITE REQLAS-i -$94.00 5EE-REQUEST PROCESSED IN 3 SU:Sllqr-SI;DAYS U <br /> SIGNATURE OF APPLICANT DATH <br /> FILE ADDRESS <br /> ANN <br /> IV Z <br /> J <br /> r.'W'11 <br /> jsu <br /> A)' <br /> ENVIRONMENTAL HEALTH DIVISION FILES. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CJ HOUSING A13ATEME14T in 501.10 WASTI:I CILITY <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 501-IDWASIT-.11EHICLE <br /> UNDERGROUND TANK(MONITORINGfREMOVAL) 0 DOG KENNEL 1-3 DAIPY <br /> 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> TIERED PEkMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCIINARO(CHEM TOILVTS <br /> 0 TATTOOtBODY PEIRCING 13 POOLISPA 0 LA14D USE APPIXATION SITES <br /> 173 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM El OTHER^EAS --SPECIFY ABOVE;) <br /> I. List up to ten addresses in the space above. Select the type(s) of files from the lis above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fai-tc) (209) 4CA,0138_,ormail tolht) <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 rive business days but no later than ten (10)days after receipt ofalplication. The files <br /> will be hold for a Maximum of five business days for review. Appointments ShQ.tild be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immedlazally avallalle 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 E � Laf <br /> of the applicant. Future file reviews by the same applicant may require a$78.01-1 ,, <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 INITIAL'S <br /> REVIEWED YES NO REVIEW DATE <br />