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04/ 07/ 20 4 � 0I118 AGE STDCKTON _ PAGE 0]. / 01 <br /> �' " �� ��' `F �� "SA�N`J(� JUIN COUNTYPU13LIC HEALTH SL tViCES zIeLOGNUMeea <br /> APR 0 T 2003 ENVIRONMENTAL HEALTH DIVISION APR ^ <br /> 304 EAST WEBER AVENUE, THIRD FLOOR I <br /> ENVHUtVMENT HEALTH STOCK70N CA 95202 1 /✓�J (,/^(� <br /> PERMIT/SERV (209) 468-3420 <br /> I�€9LIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESS/AGENCY red CaiLBILMOP1"A _._.,c <br /> ADDRESS y) Q ((� d 09 9 S.- <br /> PHONE Caov yla �- /C)p .�, rdo <br /> FACSIMILE <br /> TENTATIVE" APPOINTMENTDATEQxTIME <br /> (Please give 7 to 1e business days from data f applicStlon submi(tal) <br /> CHECK BOX TO EXPEDITE REQU T • $ ".00 FEE — REQUEST)PROCESSED IN a BUSINESS DAYS 1 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS - <br /> r <br /> Lie i <br /> Q a — <br /> ! ! II y — <br /> !1 "n- <br /> to <br /> M F17 <br /> 11 • 11 Il ♦ —� — <br /> q 11 r1 • f 1 . `I - — <br /> }}} ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ❑ S0010 WASTE FACILITY <br /> OTHER CLEANUP SITE (NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK (MONI ORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG 'TREATMEIiT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL C3PIIMPER TRUOIVYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <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. Fax to (209) 464=0138 or mail to the <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 application. The fllo4i <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. ' A file that is actively being worked on by EHD staff may not be Immediately available 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 reorganized by EHD staff at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a $78.00 dope W-70 vt9Wt r R <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff, a <br /> 6. Applications received after 3: 00 pm will be processed the next business clay. 0 t ' �ig�/ - 1'" <br /> CONFIRMEDAPPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> eH 00 14 m®arou = __ <br />