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•FRurI ;f-TA Environmental PHONE NO. : 209 369 4228 JLVI. 11 2003 11:05AN P2 <br /> SAN 1JeAQUIN COUNTYPUBLIC HEALTH •a C:RVICES tHD%oc H@da[R'� C <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JUN 1 1 2003 304 EAST WEBER AVENUE,THIRD 1-1-00K <br /> STO(;KTON CA 95202 <br /> !.`NVIRGfd�AEi`JT HEALTH (:)09)468.3420 <br /> PERMITISEFVV10ES PUBLIC RECORDS RELEASE APPLICATIOIV <br /> APPLICANT 21 C% 1�a el. / BUSI/N1_"SSIAGENCY_L/n,4 <br /> ADDRESS( ZZ- U, 0101s4a LJ' r•2 LOL7', ' // qq <br /> PHONE <br /> TENTATIVE'APPOINTMENT DATE u �{ /(.>^-l-�r—�J- TIME9_•(1;� ,�.,.•+.• _ <br /> (Please give 7to 10 busfnei.s days trom dtsptapPlfratiOn!fuamiti11)Or Z7 <br /> CHECK BOX TO EXPEDITE REQUEST- ' ..FEE- QUEST PROCESSED IN 3 DUSINFUS DAN'.;: vil' ./ >•" <br /> SIGNATURE OF APPLICANT /`— DA=_' �4/( lvvab'I 3 <br /> FILE ADDRESS THIS 8310E F ktD fiTAFF USE ONLY <br /> PROG RANI ELEMENTS SEARCH <br /> 2l(o I'iv U 93(o Sdnc '}o r2 ..-. <br /> QQD n ck�o1 _.__ —' <br /> __.---- <br /> H 4,76 <br /> e <br /> 7 <br /> -. <br /> r4 4- <br /> tlpµ <br /> • T •' 1L, <br /> 11 / M•ner <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> $r UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Cl SOLIC WASTE FACILITY <br /> X'OTHER CLEANUP SITE(NON-LOP) ❑ FOGD FACILITY N SOLIr WASTE VI-HICLI3 <br /> 1r UNDERGROUND TANK(MONITORINGlREMOVAL) ❑ Doi; KENNEL Ci I;AIR1' <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ F'KG 1RE14T111117r PLANT <br /> ❑ TIERED PERMnTED FACILrfY ❑ MO-EUHOTEL N PUMP I_R TR11CK1YAREICHEM TOILETS <br /> 0 TATTOOMODY PEIRCING ❑ POOUSPA 11 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUE LIC WATER SYSTEM ❑ OTHE1(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files fro-n the list above by checking <br /> the appropriate box(es). At least One file lype MUST be Selected. Fax to :?09 464-0138 or mail to the <br /> address indicated above. 1 <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment.for rerrievi will be confirmed <br /> approximately five business days but no later than ten (10) days after rechipt o1`applicaCiorl. Th+:files <br /> will be held for a maximum of five businee s days for review. Appointinen,s should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by FHD staff may not be immediately available for review_ A new <br /> application may be submitted when the filD Is available. <br /> 4. Any file not returned in the same condition as released will be reortlanizotI by EHD staff at the e�tpense <br /> of the applicant. Future file reviews by th(i same applicant may require a :;89.00 deposit:prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will btu processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME: <br /> DATE CONFIRMED PHONE FAX IIJCI"IAI_S <br /> REVIEWED_ YES _ NO REVIEW DATE T—T <br />