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21-03 11:41am From-ENVIRON RE LLE 5106559517 T-564 P-02/OZ F-592 <br /> �lkhVIMM -3 it - �F� V" <br /> JOA N COUNTYPUBLIC HEALTH SER,,4F_S <br /> _?? <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 2 1 2003 304 FAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 96202 <br /> INVIRONMINT - (209) 468-3420 <br /> �- LIC RECORDS RELEASE APPLICATION <br /> T/�LRN <br /> _PFRM1 10 <br /> PPLIGANT VA jRUsINEssjAGF_t4CY F N V I?Z-kl I <br /> DORIESS SLd� 700, -Fgwjajyme, <br /> HONE 6 10) 655 <br /> FACSImn-E t <br /> L5���_7� ' <br /> TENTATIVE*APPOINTMENTDATrz ?I&M- rail b2l-1e- TIME <br /> (Ple"a gIve 7 to 10 builynsa dOyr. fromdate of application Nubmiltal) -,11-0 <br /> rXpg0j-M RFOUEST-$89.00 FEE-REQUEST PROCESSEn IN 3 BUSI NESS DAYS <br /> ;IGNATURe OF APPLICANT r:i.A <br /> n�== <br /> THI:5; FT <br /> CA ITS SE <br /> FILE ADORES CH <br /> PROGRA14 EI-EMENI'SSE..... <br /> ---1C5__11rF__raX. <br /> d*- <br /> IS <br /> 14"' <br /> L FAIt <br /> MS <br /> Q <br /> '_-L Marker <br /> ENViRONMENTAL HEALTH DIVISION FILES <br /> VI./UNDERGROUND TANK (UST)CLEANUP SITE {LOP) 0 HOUSWG ABATEMENT ❑ SOUD 11\/ASTI:FACILITY M <br /> 0 ZJD vVASTR VI-NICLE <br /> _/OTHER CLEANUP BITP- (NON-Lop) C FOOD FACII-ITY <br /> C DAIRY <br /> it/UNDERGROUND TANIK (maN(TORINGIREMOVAI-) M DOG KENNEL <br /> V 13 CHICKIEN RANCH M 11WT(�ZEATMENT PLANT <br /> '.jjA7ARpoUs WAsTe o 15-NiaFEATOR 1.1 PWjP1:.'1R TKU(;KrYARDXHC-,M TOILIET-3 <br /> MrTIERED PERMITTED FACILITY in MOTELMOTIEL C3 L#jjD JSF.APPLICATION SMS <br /> * TATTOOMODY PRIRCIIYG C POOLISPA 1. <br /> * MEDICAL WASTE FACis-ITY M Q OT?iER (PLI--JV;E SPECIFY Aoolvltl <br /> 1. List up 10 ten addresses in the space above. Select the type(s) of flI85 frOrrl the 11st above by aiec king <br /> the appropriate box(es). At least one file type MUST be selected, ftUc2.j22L4, 0 n <br /> 2. EHD will notify the applicant it any EHD files exist. An appointmentfor ivv'i ow m6il be confirmed <br /> approximately five business days but no later than ten (10) days afterereLpt of-application. Thar_ tiler, <br /> will bo holts for a maximum of five business days for review. AppointrntntfS. should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked an by F-HO Staff may not be imIndial2l1jr avaiitahle for relo'lew. A now <br /> applic&ljor, maybe Fubmitted When the file is available- <br /> 4. Any file n%zit ratumed in the same condition as released will be reorganii:edl by EHD staff at the ox;iunse <br /> applicant may require a$M19-0C deposit io�r'iqrt I-Ov.11W, <br /> of the applicant Future file reviews by the same <br /> 5. 'TENTATIVE appointment dates must be confirmed with F-1-10 staff, <br /> 6. ; <br /> Applicatichris received after 3:00 pm will be proeesS®d the next business d,-my. <br /> CONFIRMED APpOINTMENT DATE TIME <br /> DATE MNFIRMED PHONE FAX <br /> REVIEWED YES NO RIEVIEWIDATE <br />