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04/07/2003,,)fF�4� 118 AGE STOCKTON PAGE 01/01 <br /> I }IC�� <br /> liNoLOG uNeea <br /> 'UIN COUNTYPUBLIC HEALTH Sr, , ICES <br /> APR 0 7 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR I <br /> ENVIRUNMENT HEALTH STOCKTON -3 95202 <br /> (209)466-3420 3L <br /> PERMIT/SERVOUBLIC RECORDS RELEASE APPLICATION <br /> I <br /> red APPLICANT ,APPLICANT ` BUSINESSJAGENCY � <br /> ADDRESS ^^A �A4 d ea (fJ9n s- <br /> PHONE �IJS L/T 7(J�fco k' FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE'S Chi l C(1 ll�ir `^ TIME �-I D- <br /> iv <br /> (Please give 7 to I0 husiness days from date f application s t.miltaI) • <br /> y�CHECK BOX TO EXPEDITE REQU T.$91.00 FEE-REQUEST ROCESSED IN 0 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> v 14n tj r I LP91 NAM <br /> i • <br /> Q 1 — <br /> LtT Ll — <br /> 11 <br /> VdAyl o ®k21 <br /> HUM <br /> ENVIRONMENTAL HEALTH DIVISION FIE <br /> APR 10 2003 At <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE I'ACILl7Y <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrrORINGlREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMEI41 PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCI4VYARO/CHEM TOILE75 <br /> O TATTOO/BODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY El PUBLIC WATER SYSTEM 13 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 to209 464-0138 or mai) 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 tilGs <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 now <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned in the same condition as released will he reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a $78.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will he processed the next business clay. — <br /> ,t <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EH 00 14 e1N]p0 <br />