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r K�n'1 : NOA Env i ronmen to I PHONE NO. 209 369 4228 <br /> �AIERECEIVEb, Dec. 03 2002 02:54PM P2 <br /> ,+ I h} t (( C�+i i�1/ r ,..� EMQ SOC NUMBER <br /> ;n}I �� i� �/I0_� JbOAQUiN COUNTYPUBLIC HEALTH SLRV10ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> OEC O 3 2002 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> STOCKTON CA 95202 1065 iNViRONMENT 1-1EALTH (209)468.3420 <br /> PFFj1'01T//SFRgV,ICP-1I3LIC RECORDS RELEASE APPLICATION <br /> APPLICANTA_ 13RA -Are 4 BUSINESS/AGENCY r4bA- :ENVI P_0N 1C-N'Y'AL,,. <br /> ADDRESS/ .Z� *D tJ I TEN LANE LUD I <br /> PHONE (U FACSIMILE �za`iJ 3109 r Z�B <br /> TENTATIVE*•APPOINTMENT DATEI7-•' I;L—DZr TIME 10* ev 4Wy�� <br /> (Piease give 7 to'10 business days from date of application submittal <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE_REQUEST PROCESSED IN 3�l�IME�!YS 14 <br /> SIGNATURE OF APPLICANT �{ � DATE (Z-3-D2- <br /> FILE ADDRESS THIS SIDE:EHD STAFF USE ONLY <br /> LOdI �5 � PROGRAM ELEMENTS SEARCH <br /> 1�12q IJ•Gvi Avc.. t�•Is5'o3' N. Gv+ld . ", <br /> 1 ' t,vytad W I G t <br /> ✓✓, t2.2Q ic�oir � <br /> X ' <br /> OZ N, C!J A^— <br /> ✓ 62( .c. 'C.}. <br /> 133 E. "I v✓vu�lr �d. t i,t "t- �7 r't: <br /> ENVIRONMENTAL HEALTH DIVISION FILES VJW r zA�C- �CV4AAS <br /> 9.UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Q SOLID WASTE FACILITY <br /> IFL OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY ' <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH . 0 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY d MOTELIHOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES • <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 19 OTHER(PLEASE SPECIFY ABOVE) <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(2091464-0138 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 be 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 new <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 expense <br /> of the applicant. Future file reviews by the 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 be processed the next business day_ <br /> CONFIRMED APPOINTMENT DATE. TIME ' <br /> DATE CONFIRMED .-PHONE FAX -INITIALS. <br /> REVIEWED YES NO REVIEW DATE <br />