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MAR-19-2003 11.:58 - TECHNICON P. L%01 <br /> DATE RECENED ��, '11� L"LOIS nvneen <br /> SAN dOAf*,N COUNTYPUBLIC HEALTH SEOGES <br /> ENVIRONMENTAL, HEALTH DIVISION <br /> MAR 1 9 Z003 304 EAST WEBER AVENUE,THIRD FLOOR I I /VI/ <br /> STOCKTON CA 95202 <br /> 5 <br /> I N7 ALTH (209)458,3420 <br /> I ERviCE PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT hrnas BUSINESSIAGENCY ICGhAiIA [(]Q,p�'ifyA�- QG-. <br /> ADDRESS X39 N gr6.r�,= T' Ste Ios -- <br /> HONE MDL-9-�ll _ FACSIMILE 91�7G'9Z44 <br /> TENTATIVE*APPOINTMENT DATE 3b7IDl TIME <br /> (Plaasa give T l0'10 husfieu days from Bata of application autxnKlaO <br /> 17 CHECK BOX TO EXPEDITE REQUEST-S89,00 FEE-REQUEST PROCESSED IN 3 BUSINESS VA-Is <br /> '`SIGNATURE OF APPLICANT C DATE <br /> ' 'rH13 SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS PROGRAM ELEMEIQTa SEARCH <br /> hyI - <br /> T <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> X UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITYE! SOLID WASTE VEHICLE <br /> ❑ OTHER CLEANUP S1TE(NON-LOP) ❑ FOOD FACILnY ❑ DAIRY <br /> �(. UNDERGROUND TANK(MONITORINGIREMOvAL) ❑ DOG KENNEL ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 LA14D USE AP? ICARDICHET T07LE:TS <br /> ❑ POOUSPA ❑ LAND USE APPLICATION SRES <br /> ❑ MEDICAL <br /> 0 OTHER(PLEASIESPECIFY ABOVE) <br /> ❑ MEDICAL WASTE FACILITY <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 oma the <br /> address Indicated above. <br /> ll noUfy the <br /> licant it any Zriu flies <br /> r review <br /> l be <br /> 2 EHD approximately five business sten days but no laterappointmentxist. An <br /> than n ( 0) days after receipt lconfirmed <br /> receipt fVtpplic t on <br /> xThe 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 Immedlately,available for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any Ilia not returned in the same condition as released will be reorganized by EAD 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 /> 6. Applications received after 3:00 pm will be processed the next businoss day. <br /> CONFIRMED APPOINTMENT DATE TIME. "— <br /> DATE CONFIRMED .— <br /> PHONE FAX. INITIALS <br /> octnCWFn YES NO REVIEW DATE <br /> TOTAL 13.01 <br />