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\ 09-04-2691 11:38AM FROM Tf <br /> �'l , :'' s N JOAQUIN COUNTYPUBUC HEALTH SERVICES <br /> Or ENVIRONMENTAL HEALTH DIVISION <br /> 344 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> 13LIC RECORDS RELEASE APPLICATION <br /> APALI AlQT PX S�lll �i SQ_N SUStNESSJAGEHCY <br /> ADD s s �� 2 NQ, A—t U <br /> PHON )S g�� ~ I DC) FACSIMILE I (L 1 s 1 g g 9 -J Lpy I <br /> Tf INTATIVE-APPO NTME? T PATI: ( �� + `� T101✓= ��� • <br /> (Ploar.'u give 7 to 10 tsusuapss d 's from claw of application! bmhLa) - <br /> LI <br /> CHECK BOXY0 EXPEDITE RTQUZS'jr-$2,T.00 FEE--REQUEST PROCESSED 1N 3 SUS1HE55 GAYS <br /> I <br /> '81GtNL TURF OF APPLICANT DATE <br /> I <br /> FI ADDIiE33 TiilS SIDE ENO STAFF USE ONLY <br /> PROGRAM ELEMENTS SL'ARGN <br /> Zz 3} 22 z 5iy. <br /> 3 S oU Tl-i ao o Wit✓T 3�i ,23 �Sc�, =3 ,( Z2_ <br /> ��I12 5c►�'>;H � '6a,i�b STfzE�i 4?,c µ�lG <br /> �I Olt; 1l Amo. Tf-EF.T 2-,2-,2-3 44) <br /> ��io So�rr CAL- ,1--iv1A :5 T TeEc-r .4 aL,4 Y. 4 2- <br /> 07 <br /> S;• 21,, - ENVIRONMENTAL <br /> 9Mv Ai� ZZ isl0ly F1Li=s D �15�L5L0 <br /> UNpERGrtOUND TANK(UST) L�NUh SITE(LOP) 17�F{OUSING ABATE1YlENT 5 <br /> vLJD was71:I AC► <br /> NT <br /> OTgF-R CLEANUP S(fE(NON, P) ❑ FOOD FACII ITY SOLID WASTE VEHICLE SEP 13 2001 <br /> UKIPZRGROUNE)TANK(MONI"`III�(0)RINGIREMOVAL) d DOG KENNEL DAIRY <br /> KA#ARDOUS WASTE GENE TOR 0 ChiCXEN RANCH PKG TREATMENT PLANT <br /> 71E? ZEo PERMITTED FACIL.r m tAoTEUHO'rPL PUMPER IRUGKlYARINCHEMTDII.ETS <br /> O TA T001BODY PEIRCING O POOtISPA LAND USE APPU CATION SITES <br /> a 1V r-91CAL WASTE FAC1LrrY 0 PUBLIC ViATER SYS7EM M OTHER(PLBASfa SPECIFY ABOVE) <br /> 1. List up ta•ten ad resse5 in tho space above. Select the typo(s) of fills from the list above by checking <br /> the appropriate X(es),:At least one file typo MUST be selected_ Fax to (209) 464-0138 or mail to the <br /> i n dress in 'cats e_ <br /> 2 EHD will notify the applicant if any END flies exist_ An appolntment for revlaw will be confirmed <br /> approximately fl*o busirt.ess days but no later than ten(10)days after receipt of application. -The tiles <br /> will be field for a j-i�aximurn of five business days for review. Appointments should be scheduled <br /> accordingly . <br /> 3. A file that is activaly befog worked on by EHD staff may not ba Immediately available for review. A new <br /> appdicatioh may lie subrriitted when the file is available. <br /> R. Any file not retur ed in the same condition as released will be reorganized by EHD staff at the expense <br /> S. Iof the applicant. 'Future fiie reviows by the same applicant may require a $37.00 deposit prior to review. <br /> `TENS A- WE appointment dates must be confirmed with EHD staff. <br /> 6. ! Applical'tons rec ived after 3:0Q pm will be processed the next business day. <br /> i <br /> i <br /> .CoN�IRMED APPOINTMENT DATA~ TIME <br /> DATEICONFIRIVIED PRONE FAX INITIALS <br /> 1;>rIIJEWir~D YE NO REVIEW DATE <br /> 04 00 14 .off A TOTAL P.01 <br />