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.vvvii <br /> DATE �002i003 <br /> 1 ' C �1eHo WGeeie <br /> I�:,[ ?"� ENVIRONMENTAL <br /> IN COUNTYPUBLIC HEALTH SERVICES <br /> N IRONMENTAL HEALTH DIVISION <br /> APR 3 0 2003 304 FAST WEBER AVENUE,THiRD FLOOR <br /> STOCKTON CA 95202 <br /> cNVlRU'IMENT HEALT�� (z09)4613.3420 I <br /> Df7 1 , .. NUBLIC RECORDS-RELEASE APPLICATION <br /> APPLICANT N;'/p /r'J <br /> "'�!2E BUSINESSIAGENCY Ac nit t 1 ter. <br /> ADDRESS •''– . •ti <br /> a'�' ►',ref-� �S-s- <br /> PIiONt;_ qye-- J y FACSMILE <br /> TENTATIVE*APP0INTUfNT DATE �7/a 3TIME C:2 <br /> (Please pive T to 10 business days from date of appll=aon submittal) -7 <br /> r3 CHECK BOX TO EXPEOrM REQUEST.SOT.00 FEE • � �"" <br /> REQUEST PROCESSED IN r!BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> E <br /> ELLE ADDRESS 5 SIDI!EHD 3 M71 <br /> PROdRIsi,M_ELE1h&M <br /> Cou.++r Club lSly ; <br /> o I <br /> R !O � c r91y !v <br /> y eun 4-r Gly l✓ <br /> �� <br /> fi(A 7 S ount.� Ch•S 111 rL <br /> Rx70 ., CIu6 IY <br /> 7:t.5 C oc.n+►- c 1104 iv L p <br /> ENVIRONMENTAL HEALTH DIVISION FILFS <br /> ..2UND0WRDUND TANK(UST)CtEeNUP SITE(LOP) 17 HOUSING ABATEMENT O� 'Lit)WAMi E FA CMY <br /> �CIZANUF SIT!(NON-LOP) C3 POW FOFACILITY iLlia WA=YE}(iCLE <br /> MM TANK(MONITO"GIREMOVAL) D DOG KENNEL 0 pqWt <br /> G HAZARMN WASTE GENERATOR t7 CHICKEN RANCH ❑ PK0 TREATMENT PLANT <br /> G TIOM PfMfnED FACILITY G iA07MMOTEL 17 PLiMPERTRUCICYAR0ICHEM TOILETS <br /> 0 YATTOOMM PEIRCWG C POOL/SPA - ' O•LE�N[I USE APPLICATION SITES <br /> C MOWAL WASTE FACILITY O PUBLIC WATER SYSTEM O Mi:R(PLEASE SPECIFYIdWVE) <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. Fait to 209 4§4:913§or mgll to thg <br /> addms indicated above . <br /> 2. EHD will notify the applicant N any EHD files exist. An appointment for review will be confirmed <br /> aPPately 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. Appointrrlents should be scheduled <br /> accordingly. <br /> 3• A file that is actively being worked on by EHD staff may not be immediatoly a-failable for review. A new <br /> 4. <br /> aPPikation may be submitted when the file is avullable. I <br /> Any file not returned in the same condition as released will be reorganind•by END staff at the expe�ttl <br /> Of the applieanL Future file reviews by the same applicak may tequin:a 587.00 deposit prior to revla <br /> ti. *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 /> — --._ — <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />