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} <br /> OA H:W-CCIVLC.` i h:SCS P" L71J 52•' i 1'1'J'�I <br /> SAN L;Quw COUNTYPUBLIC HEALTH Sl CES ��I�3i <br /> ENVIRONMENTAL HEALTH DIVISION <br /> sw <br /> 304 EAST WEBER AVENUE,THIRD FLOORJAIL 0 2 2001 <br /> STOCKTON CA 95202 <br /> (209) 468-3420 NVIR{�iJMEW HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERMI1 SERVICES <br /> ---- -_ - <br /> APPLICANT > <br /> aUSINE55lAGG <br /> '� kS <br /> � � NCYtQlf��tY1P <br /> ADDRESS_ �� _/)ay—s-I �[�u��. /�}-] Q r, J C�Yrlx tl?Y A.�G A �'ISgc S <br /> PHONE _,1SGL`�_�-!� Q _ FACSERIILE L`!I(D� `-f "T�[7r�C� �_,. <br /> TENTATIVE*AYPOINTmENT DATE._ �K� �Q I�� � TIME l:"50 IAM <br /> (Plea"wyc T to 1i busireuss da s from dale of OppliCati=wbinittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$87,00 FEE-REQUEST PROCESSED M 3 BUSINESS DAYS <br /> SIGNATURE"OF APPLICANT _ 5 DATE _! <br /> rz FILE ADDRESS THIS SIDE ERD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARGII <br /> 5-515 kRo Ir,Ck �-oC-P m � _rte_ y1� PV 42��35a£� <br /> --4A` S-�q cY++ <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 19f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE'rACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITy ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR C1 CHECKEN RANCH C7 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 13 MOTELrHOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> n TA.TTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> I. 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.(2091464-0138 or mail to the <br /> address Indicated above, <br /> 2. EFID will notify the applicant If:any EHI] files exist. An appointment for review will be confirmed <br /> approximately five business days but no tater thar.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 j <br /> accordingly. <br /> 3. 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. <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$87.00 deposit prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHO 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 INITIALS <br /> REVIEWED m YES _ NO REVIEW DATE <br /> Ek 00 14 Oamriao - - <br />