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717:- TE � 118 AGE STOCKTON <br /> PAGE 01!.01 <br /> A `QUIN COUNTYPUBLIC WVICE <br /> EALTHS 9100 LOC HUMBER <br /> APR n 7 2003' ENVIRONMENTAL. HEALTH DIV1SION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIKONMENT HEALTH STOCKTON CA 9520, <br /> 468-3420 <br /> PERM IT/5ERVKtL1C RECORDS RELEASE <br /> APPLICATION <br /> 3c�` <br /> APPLICANT J <br /> ADDRESS <br /> 9USINESSIAGENCY <br /> ha►r� <br /> PHONE ��f 7 UI !' f✓R ! ;... <br /> FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE' QjTIME <br /> (Please give 7 to 10 business days trom date t appii at on suhmlla3l) —'r{D- �' <br /> CHECK BOX Tp EXPEDlT) REQU T-S�{,OEI FEF-REQUI 5T ROCE55ED 1�_38UsINESS Dq"'Cs <br /> S)GNATURE OF APPLICANT <br /> DATE �� <br /> FILE gb4RES5 ----- <br /> r U� 11,031r A <br /> 7 ,e ,1 ♦r ,. <br /> ENVIRONMENTAL_HEALTH DIVISION FILES <br /> UN05RGROUND TANK(UST)CLEANUP SITE(LOP) ❑ NOUSING ABATEMENT l7 SIXID WASTE I AGILITY i <br /> OTHER CLEANUP SITE(NON.LOP) 0 FOOD FACILITY 0 SOLID WASTE IIEHICLE <br /> UNDERGROUND TANK(MONITORINGIR5MOVAL) ❑ UOG KENNEL 0 DAIRY F <br /> HAZARDOUS WASTE!GENERATOR ❑ CHICKEN RANCH ❑ PI(G TRI=ATMi:NT PLANT <br /> Q TIERED PEFZMITTED FACILITY 0 a»OTEUHOTEL E7 PUMPER TRVI;ITIYAROICHEM TOILETS <br /> O TATTOOIBODY PEIRCING ❑ POOLt3PA ❑ LAND USE APPLICATION SITE$ <br /> E7 MEDICAL WASTE FACILITY ❑ PVBLIC WATER SYSTEM ❑ OTHI=R(_PLEASE SPECIFY 480VE) <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 4134_1)138 or mail to the <br /> address indicated above. <br /> 2. EH©will notify the applicant if ally 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 0 f1plication. The file: <br /> will be held for a maximum Of five business days for review. Appointments should bei scheduled <br /> accordingly. <br /> 3. A fate that is actively being worked on by EHD staff may not be Immediately available for review. A now � <br /> application may be submitted when the file is mailable. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the QXPense <br /> of the applicant_ Future file reviews by the same applicant may require a $78.00 t(Itfao to <br /> S. *TENTATIVE appointment dates must be Confirmed with EHD staff, r:' <br /> 6. Applications received after 3:04 m will be rocessed thlD next business play, r <br /> PM p 3 >' ~ <br /> CON FIRMED-APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS t <br /> REVIEWED YES NO REVIEW DATE <br /> rn Vy 14 11 �_ - <br />