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03/26/2003 11:37 2094671118 AGE STOCKTON PAGE 01101 <br /> DATE RECEIVEU, _- t` r-� — Iino Lor.Numout <br /> `��I$,0WAQUIN COUNTYPUBLIC HEALTH 1►..AVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 2. 6 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ►� ,_ I (209)468-3420 <br /> jj/rayl 1 LIC RECORDS RELEASE APPLICATION <br /> r:f"i.j' Th <br /> APPLICANT BUSlNE351AGENCY SLAMd _� I <br /> ADDRESS ^3 V_,_S1zcehm <br /> PHONE ` � 7 LR - / FACSIMILE _ <br /> r <br /> TENTATIVE'APPOINTMENT DATE TIME _; � C <br /> (Please give 7 to 16 business days from date of apptieati0n submittal) <br /> ,X CHECK BOX TO EXPEDITE REQ ST-$f4.00 FEE-REQUEST PROCESSED IN 313USINM DAYS u ' <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> A) -- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O'HOUSING ABATEMENT 11 souo WASTE:f CIUTY <br /> OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY ❑ SOLID WASTE: HICLE <br /> UNDERGROUND TANK(AONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> I�IFB/(11E38/ CI CHICKEN RANCH ❑ PKG TRE:ATMEI T PLANT <br /> TIERED PERMITTED FACILITY O MOTELMOTEL I7 PUMPER TRUCI ARD/CHEIIA TOILETS <br /> O TATTOOA300Y PEIRCING O POOLISPA O LAND USE PAPP CATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM D OTHER(PLEAS SPECIFY ABOVE:) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the Ift above by checking <br /> the appropriate box(es). At least one file type MUST be selected. ax to 209 4644 13 or mail to 1 �e <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 a) plication. The files <br /> will be held for a maximum of five business days for review. Appointments shaiji be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately avails le 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 reorganised by E a . <br /> of the applicant. Future file reviews by the same applicant may require a$78.0( o <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 INITIJk <br /> REVIEWED YES NO REVIEW DATE <br /> RH 90 14 GIAMM <br /> �� <br />