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04/07_/2.00 4� 118 AGE STOCKTON PAGE 01101 <br /> � E00 LOU IIUN9FR <br /> �QUIN COUNTYPUBLIC WEALTH : tWICES <br /> APR (1 7' 2003 WNVIRONMENTAL HEALTH DWISIOhi <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTHSTOCKTON CA 95202 3c <br /> (209)468-3420 <br /> PERMIT/SERV _ <br /> OUSLIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESS/AGENCY adilamed 'Amt I <br /> ADDRESS ((� dice <br /> -- _ <br /> 1"i 4; <br /> PRUNE C;Dq 7 UI �DQ FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE.^ ( �^ TIME , _ �S)- <br /> (Please give 7 to 10 business days from date f app1161lon sunmivap -� • <br /> CHECK BOX TO EXPEDITE REQU T-391.'00 FEE-REQuEs ROCS55ED IN 3 BUSINESS Dq"rS <br /> UP <br /> SIGNATURE OF APPLICANT DATE _ <br /> FILE ADDRESS <br /> 3. <br /> • _ '^ fj z <br /> r� � r� rfs � � . .•, �y <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) © F=OOD FACILITY ❑. SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(NIONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR Cl CHICKEN RANCH ❑ PKG TREATMiIEN'T PLANY <br /> TIERED PERMITTED FACILITY O MOTELIHOTEL 0 PIJMPI=R TRV4''I'VYARD/CHEM 701L.1=TS <br /> ❑ TATTOOISODY PEIRCING C] POOLISPA 0' LAN[)USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY 11BOVE) <br /> 1 Dist 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(208)464.0138 or m'tif to the <br /> address indicated above. <br /> 2. EHD will notify th•e 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 OfiPlication. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fife that is actively being worked on by£HD staff may not be Immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> d. Any file not returned in the same condition as released will be reorganize(] by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$78.00 drtpo [oto <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff, <br /> B. Applications received after 3:00 pm will be processed the next business clay. <br /> CONFIRMED-APPOINTMENT DATE TIME <br /> 5 DATE CONFIRMED _ PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> En 00 14 641Osroe _ <br />