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04/07/200 118 118 AGE STOCKTON I-NDLOG NU BnE 01/01 <br /> in ,I,L t AN JUIN COUNTYPUBLIC HEALTH SAICES <br /> APR O 7 2003 ENVIRONMENTAL HEALTH DIVISION APR I� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR J <br /> ENVIHUNMENT HEALTH sr (209 46e-3420 <br /> CA sszaz (�/�[' <br /> PERMIT/SERV zgs) <br /> ��LIC RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGENCY�}�a6 d�PQ,Fnu1«l Qn7n <br /> ADDRESSP. <br /> / ^n ��Q{lJ (� `R CI s PHONE Is`�V7 7((1 / ' I�.�,/ - F,ACSIMILE �,If r <br /> TENTATIVE*APPOINTMENT DATE' TIME _ __ �-�0 0-13 �> <br /> (Pioase give 7 to'ID puslness days from date f application sunmiltal) /N, a <br /> '-y-�CHECK BOX TO EXPEDITE REQU T.$01.00 FEE-REOUEST ROCESSED IN 7 B � 1USINESS DA � " ' <br /> SIGNATURE OF APPLICANT DATE J _ <br /> FILE ADDRESS <br /> v t Lie I s <br /> a � — <br /> 4 \v C Le G <br /> rf t. rt ♦ - <br /> 1 MA%N <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1 : 200 <br /> A� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILry A " <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PI(G TREATMEGNT PLANT <br /> Q TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUM5'ER THUVYARDICHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITE$ <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM 13O"THER(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 (209)464-0138 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 filos, <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 1 A Nle 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 /> a. 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 $78.00 daposit 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 business clay. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> cn oo a mrosroa —_ - <br />