Laserfiche WebLink
MARCUS H . BOLE ASSOC 590 635 0119 09 / 22 /03 02 : 56pm P . 001 <br /> ,..., � .....a, r _. . _ _ , ._. .. ._ . . . ... ._. ,� <br /> ul I, i JAI rJ l_li SAN - JAQUIN COUNTYPUBLIC HEALTH SEk VICES ` E1e• �oc NUMa R <br /> ENVIRONMENTAL HEALTH DIVISION ' I <br /> 304 EAST WEBER AVENUE, THIRD FLOOR <br /> SEP 2 2 2003 STOCKTON CA 95202 <br /> (209) 468-3420 <br /> c.I ' 'IROPIiVILW HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> prRpn ; r ; 5 <br /> APPLICANT J (�/ S BusmEssmoG NCY � /y B �� <br /> Soo G <br /> ADDRESS./az fEpck c/ IVA= GLJ jQ G <br /> PHONE -0536 6 33 no FACCdSA SIM[IILE,( D 1::636 <br /> TENTATIVE' APPOINTMENT DATE ! I' � ay .:'P — 3 og <br /> (Ploase NIve T to ID hIILIMss Bays from dale of apPlicntlon submlllal) S <br /> • <br /> CHECK BOX EXPEDITE REQUEST FGE - REgUEST PROCEs D IN 3 BUSINESS DAYS UA0 <br /> SIGNATURE OF APPLICANT 4.-- DATE 9 72 a3 <br /> FILE ADDRESS THIS SIDE CHO STAFF VSe ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> (/ <br /> © r <br /> ENVIRONMFNTAL HEALTH DIVISION FILES <br /> la DERGROUND TANK JUST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> D OTHER CLEANUP SITE (NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> irDNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY - <br /> I?!`MA2ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT , <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL O PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOO/BODY PEIRCING ❑ POCLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER (PLEASE SPECIFY ABOVE) <br /> 14 List up to ton 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 (2091 4G4-0133 or mall to the <br /> address indicated above, . <br /> 26 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, Appointmonts should be scheduled <br /> accordingly. <br /> 3. A file that 1s actively being worked on by EMD 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 be reorganizod by EHD staff at the expense <br /> of the applicant, Future file reviews by the same applicant may require a $59000 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 />