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10/28/2002 16: 09 209467111.R AGE STOCKTON PAGE 01/01 <br /> 4H1 r-KC4tj� EHD LOG NUMBER - 10 <br /> SAN JO _ tUIN COUNTYPUBLIC HEALTH SE. . ICES <br /> 10 ENVIRONMENTAL HEALTH DIVISION 19%0W <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> y STOCKTON CA 95202 D J <br /> (209) 468-3420 <br /> p LIC RECORDS RELEASE APPLICATION T 98, ?`l0? <br /> APP ��f INE55(AGENCY D U �L I I I <br /> Q <br /> ADDRESS o P FRrdi!ii; <br /> PHONE ao g) y� 7 ioa6 FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE t-/ I)LV� I zoePI TIME -W PA <br /> (Please give 7 to 10 buslnass days from dats of application submittal) <br /> 420r6V- <br /> CHECK <br /> � a <br /> CHECK BOX TO EXPEDITE REQ UE 78.00 FEE—REQUES P OCES En IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATELOC I, <br /> FILE ADD E <br /> yy f, At <br /> 4MW4,r YWM 6 <br /> 30 f7 A <br /> l <br /> r l <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LDP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY M SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL In DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH G PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY © PUBLIC WATER SYSTEM U 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 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 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 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INI7iALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 09 14 01 05 00 <br />