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Mar • 10 . 2003 12 : 25PMC"' P, EARTH TECHNOLOGIES IN 030 P - I/I <br /> PATE RECOVED <br /> �J18 TQC Ktlt48F.R <br /> — ; t -. J( AQ COUN7YPU LIC HEALTH SERVICES�r1� ,���J�[E Fr) , ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WE5ER AVENUE,THIRD FLOOR <br /> MAR 1 0 2003 STOCKTON CA 95202 <br /> (209)468-3420 <br /> tNVIRUNMENT >-IEAL I j13LIC RECORDS RELEASE APPLICATION <br /> ori'lp 414;4+r <br /> APPLICANT Nf(CH79J=L #eKJ✓E'J'1L� >3U5tNESSIAGENCY �o/V�t� { rf4 <br /> ADDRESS ICC Ty 1 f 7 E <br /> - - Z <br /> PHONE FAcswLE 2 o . z34 O538 <br /> -r -- <br /> TENTATIVE*APPOINTMENT DATE <br /> (Pleasegive 7 to 10 bU$;ness days from date of apps Ubtni <br /> � <br /> CHECK BOX TO EXI'EAiTE REQUEST-$8 .QO FEE-REQUEST PROCESSED 1N 3 BUSINESS DAYS u rj ja� t <br /> SIGNATURE OF APPLICANT DATE _340 <br /> PILE ADDRESS THIS SIDE i-NO STAI=I=I.ISE ONLY <br /> PROGR"ELEb1EI ms SEARCH <br /> UNIOAI �O l <br /> _VAffMdjLVZEr=A <br /> w <br /> b loN 17o y _ <br /> ENVIRONMENTAL HEALTH DIVISION PILES <br /> j2�. UNDERGROUND TANK(057)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT I'd SOLID WASTE i;AGILITY(I-CAIµ4-) <br /> )5 OTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY ❑ SOLID WASTE'VEIUCLE _ 1 n CZ UM12- <br /> BL UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY T _ <br /> -HAZARDOUS WASTE GENERATOR 1n CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> a. <br /> TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPER TRUCIG'YARO/CHEM TOILE'T'S <br /> Q TATTOCIBODY PEIRCING ❑ POOUSPX ❑ LAND USE APPLlCA'nON SITES <br /> ❑ MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVF) <br /> I. List up to ten addresses in the space above. Select the type(s) of files front the li=.t above by checking <br /> the appropriate box(es). At least one file type MUST be selected, <br /> fax to 299)4ta4_0138 or mail to the <br /> address indicated above <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will lie confirmed <br /> approximately five business days but no later than 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 <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A,nfaw <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 expen*e <br /> of the applicant. Future file reviews by the same applicant may require a$97.00 deposit prior to revkm. <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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX -IN.IT1ALS <br />