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04/07 <br /> AGE ST Ot�i 11$ PAGE 07./01 <br /> w. <br /> GOO l06 NUMBER <br /> UIN COUNTYPUBL►C HEALTH S t ...'►CES <br /> AP R n 7' 2003 ENVIRONMENTAL HEALTH D►VISIOI+l <br /> 304 EAST WEBER AVENUE,THIRD FLOOR. <br /> ENVIRONMENT HEALTH STOCKTON CA 95202 <br /> PERMIT/SERV (209)468-3420 <br /> LIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY /y t <br /> ADDRESS •}^� [ j��Q Gf/� f K (7 <br /> PHONE 17- <br /> ( -- FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE'�1 TIME _ --� �`Q �J > <br /> (Please give 7 to 10 business days from data f application submiiLal) <br /> too <br /> CHECK SOX 70 EXPEDITE REQ U, <br /> LAOM <br /> T-$91.00 FEE—REQUEST)ISROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> r UE' Pb L4i R e <br /> 1f o/ ®I to <br /> vN4 O — _ <br /> •' It ♦e ♦r is ^'I � <br /> D <br /> ENVIRONMENTAL HEALTH DIVISION FILE <br /> FT� <br /> APR 10 2003 <br /> UNDE=RGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PI(G TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL O PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING O POOUSFA ❑ LAND USE APPLICATION SIT15S <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ASOVE) <br /> 1. list up to ten addresses in the space above. Select the types) 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 ma)1 to the <br /> address Indicated above. <br /> 2. EHD will notify thte 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 fife.: <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 immedinte(y available for review. A now <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:.tall at the expense <br /> of the applicant_ Future file reviews by the same applicant may require a $78.00 ditposit 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 /> A <br /> CONFIR •APPOINTMENT DATE TIME <br /> DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />