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.JO'k UIN COUNTYPUBLIE HEALTH 5 VICES <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> APR 0 7 Z003 304 EAST WESERAVONUE, THIRD FLOOR R3 <br /> STOCKTON CA 95202 I O <br /> ENVIR ( NME (209) 4WU20 <br /> MITttIbl RECORDS RELEASE APPLICATION <br /> APPLICANT ?--"�LA Y� ��( .� /C(tVl [�✓h�� .�-- BU&PIE/SSIfAfiENCY LI� �7 (9�BOI.(�70�1i <br /> ADDRESS �c./ZIo 1)_L'f J�l• , roe; ) <br /> �-•PHONE 7 ✓ _ ��b 7 ,7 �`L L � FACSIMILE <br /> TENTATIVE' APP OIN.TMEW DATE a s soon a s aoss� b�e TIME �ny>< dr..rs'n r �ruli� Si�vsS <br /> (Pkaeo Diva 7 to 70 sus�na.s «++ tivtt Of JPPlludon well hOrir(la �.,��. <br /> L-•I CHECK DQX T(i EXPIE13n1: REQUEST n SS9.00 FEE . REQUEST PROCESSED IN 3 BUSINESS DAYS i f �;ff� h5 vv e S librA hlif2(4,P5 <br /> SIGNATURE Oi= .APPLICAWT G AG GATE ,y, r - y - 15 -D.' 7Ctlaf� <br /> DE 113INJUr—dTa"S <br /> Fe.E ADDRESS PROGRAM I6LEMEM71II SEARCH <br /> (•/ <br /> MEN <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> OFACILITY UNDE RGROUND 'IANK (USTI CLEANUP BETE (LOP) 'p HQUSINO AuATEMINT p DQUD WASTE FACILITY <br /> 0 SOLID WASTE VEHICLE <br /> SCI OTHER CLEANUP SITE (NON\ LCP) p FOOD O DAIRY <br /> ❑ UNDERGROUND TANK (MONITCRINGIReMOVAL) O DOG KENNEL CI PKG TREATMENT PLANT <br /> O HATEIARDOUS v/ACENi:F1ATJR M CHICKEN RANCH inpUMPERTRUCK/YARDICHEN TOILETS <br /> M MOT"OTEL <br /> O TTPERmIrTED ❑ POOUsP <br /> O LANA USE APPLICATION SITES <br /> ❑ TATOOIBODY PNDCIHO C � <br /> ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> p MEDICAL WASTE FACILITY <br /> filechec <br /> t • List up to ten addresses In the Space above. $elect the types) of Fox from the Ilst above 38 orbmm to theg <br /> the apprnprlate Cwx(es). At least one file type MUST be selecrad. Fax to <br /> addrung Ondl SLJJbOyel <br /> 2. EHD �,xIi I y Iln business days but nnollater tt+an rles exist, un (10 days atter receipt of appllcati n.oIntmont for review will be The files <br /> pp y ointments should be scheduled <br /> will be hold for a1 m;.xlmum of five business days for review. App <br /> accorditigly, <br /> 39 A file that is actively being worked on by EHD staff may not be immediately available for review, Anew <br /> application may be submitted when the file is available. RHD staff at the exWsO <br /> 4, of thelp not applie etu Future d in the <br /> file e Con bYlt a samal applicanteased ) aY eq ire a $39rganized 7.00 deposit prior to eview. <br /> 5. `TENTATIVE Bp;wintmrnt dates muswlb be Confirmed processed the next business day <br /> 6. Appllr tions r4celvad utter $:00 pm p <br /> CONFIRMED APPOINTMf.NT DATE TIME <br /> I DATE CDNFIR}A' EiQ <br /> PHONE FAX INITIALS <br /> REVIEWED <br /> .g NO PMVIEW DATE <br /> o+o .w+ca. <br /> Ed WHS0 : 0T 200E L0 'ON Xtid WOW <br /> 1 <br />