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Au 209 12 :31PM N�" ENVIRO 209 .369.4228 No • 6236 P - 2 <br /> /'L... g.�"�I�I I\� ..— emu 40G Nurecn <br /> C I <br /> IL I��h [ ANQUIN COUNTYPU9LIC HEALTH SER . ,ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUG 2 5 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> . STOCKTON CA 85202 Iq <br /> ENVIRIJMMENT HEALTH (2051)4633420 /V <br /> PERMir SFRVirFe PUBLIC RECORDS RELEASE APPLICATION / <br /> APPLICANT C��� y�CI\ /—e f- EUSINE6S/AGENCY NeI � C/ 1-t h�<'.�SC�I'� I�SS•f`C\Q'I-('S <br /> ADDRESS eL O�. + Ii LI$+rIG1 W:Lti LCI 1 C Al '7t 5 2y0 <br /> PHONE 7- 1 I 1 /U1 FACSIMILE <Q 1 — 3 6 c) — I�Z <br /> TENTATIVE'APPOINTEIENT DATE TIME <br /> (Please give 7 to 10 businoes days from date of sppliwtion submittal) <br /> 12 CHECK BOX TO EXPEDrTE REQUEST-t89.00 F gYEST P SSGD IN 3 BUSINESS DAYS <br /> SIGNATURE Or APPLICANT 1, DATE <br /> FILE ADDRESS THIS SIDE EHO STAFF USE ONLY <br /> M Lq 1-O S 33Q PROGRAM ELEMENTS SEARCH <br /> 1726pur h r .ti n a •ati c <br /> Z �� <br /> �, to Lo i's+c <br /> f p <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> �[7}/NDERGROUND TANK(UST)CLEANUP SITE(LDP) D HOUSING ABATEMENT SOUD WASTE FACILITY <br /> "OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILRV O SOUO WASTE VEHICLE <br /> aAJDEROROUND TANK(MONITORINORtEMOVAL) U DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR C CHICKEN RANCH O PKO TREATMENT PLANT <br /> ❑ TIERED PER1AITrED FAGILIT' O MOTEL/HOTEL ❑ PUMPER TRUCK/YARDlCHEM TOILETS <br /> C TATTOO/300Y PEIRCING C POOL/SPA Dl LAND USE APPLICATION SrreS <br /> 0 MIDICAL WASTE FACILITY [t PUSUC WATER SYSTEM 0 OTHER(PLEASE SPECIFY ABOVE) <br /> I. 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 fila typo MUST be coloctod, Fax to (209)484.0138 or mall to the <br /> address indicated above• <br /> 2. EHD will notify the applicant B any EHD files exisL An appointment for roview will be confirmed <br /> approxlmateiy five business days but no later than ten(101 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 U actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted whorl tho flo is available. <br /> 4. Any file not returned in the same condition as released will be roorganized by EHD staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a $89.00 depo6it prior to review. <br /> 5. 'TENTATIVE appointment datos must be confirmed with EHO staff. <br /> S. 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 /> REVIEWED YES NO REVIEW DATE <br />