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YMO LOG MVYOEM <br /> 1b� AQU1N COUNTYPUBLIC HEALTH S&VICES <br /> ENVIRONMENTAL HEALTH pIVI �� <br /> 304 EASY WEBER AV6NUE,THIRD FLOOR / <br /> APR 0 7 2003 STOCKTON CA 95202 I <br /> (200)4611-M20 <br /> MVIRUNMENT i'iLi BUG RECORDS RELEASE APPLICATION <br /> (AHVIUS <br /> PPLICANT ( BUSiNESSlAOCNCY _. URS �'Vr-prr.ik7 <br /> {ADDRESS <br /> HONE PACSIMILE (srv��7s�-3aag A S�iI;Jvp /Lf>rqt !/! <br /> TETAITVE'APPONTN¢NTOATt AS54cnA4 �a5516��' THE A5 Brit& (Xhtrrs t� <br /> t➢4+s.elv�T to 10 Euctnaer cloys from date of appSatlan submttleU � <br /> I�acw �5-0 3 <br /> CHECK BOX To EXIVDRE REQUEST-5&9.00 FEE-REQUEST PROCESSED IN a BUSINESS DAYS <br /> 'SIGNATURE W APPLICANT AA :6//Ur 4e JOArA Art Z _ DAT , <br /> /F- s 810E END STAFF USE ONLY <br /> FILE ADDHESS PROGRAM hLEMENTS SEARCH <br /> \ ENVIRONMENTAL HEALTH DIVISION FILES <br /> U UNDERGROUND 71W K Nr)CU:ANUP ST6(LOP) ❑ HOUSING ASATCMLNT ❑ SOUD WASTE FACILITY <br /> SO OITtHR CL=,F SITE"-Lop) L1 FOOD FACILITY C7 SOLID WASTE V&MCLIF <br /> UNOORQUND 7/UNK(MON RDRNGM"oVAL) 0 DOO KENNEL O DAIRY <br /> ER <br /> . ' ❑ HAZARDOUS WASTE 0ENFRATCR in CHICKEN RANCH t] PCG RUSN'r PLANT <br /> [iTIERED PERMITL-U TJJ <br /> FACILrrr ❑ MOTNOTEL PUMPER <br /> TRUCK7YAROICHEN TOILETS <br /> O 7ATT00160DY PIaRCI):G LI POOLISPA t7 LAND USE APPLICATION SITEs <br /> G MEDICN.WASTE FACULTY O ❑ OTHER(PLk.ABE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the typo(&)of clas from the <br /> he that abovobm I checking <br /> the appropriate boxres). At least one file type MUST be selected. <br /> atl •L7,D�. itA?O <br /> 2 EHD wi71 notify the zppueant d any EHD files oxIr tat. to appointment10daysafterreceipt f application. The files <br /> approxIm <br /> hold for <br /> five business days but in later than r ( ) YS should be scheduled <br /> will to hold fOf a my,Kimum Of five business days for review. Appointments <br /> accordingly. ) y latel available for review. Anew <br /> 3, A file that is actNel being worked on try EHD staff ma not he irnrrled Y <br /> application may be submitted when the file is evallable. at <br /> of file not r9turiioti in tile <br /> Future fllesroviews byame the samtion as e app canteased lmay Tequlrt a s OO deposbe reorganized by EKID it Staff P onto re <br /> eview. <br /> 5, `TENTATIVE appointment dates must be Qonfirmod with EKO staff. <br /> g, <br /> Applications reuyv¢d after 5:00 pm will be Processed the next business day. <br /> CONI-IRMED A3PCINTME14T DATE TIME <br /> 1 DATECONFIRt.IW <br /> PHONE FAX INITIALS <br /> RaVIEWED YES NO REVIEW DATE <br /> rrm <br /> Ed WUGO:OT '12OOZ LO '1dd : 'ON X1Jd WOad <br />