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♦..:c nc�GvU <br /> :3AN JOA, N COUNTYPIJBLIC HEALTH SERVICE <br /> 111 n 7 L003 EN ..,ZONMENTAL HEATH DIVISION <br /> :;o, EAST WEBER AVENUI--,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> i';'i(,FS (209)468.341.0 <br /> RECORDS RELEASE APPLICATION <br /> APPLICANT_ �i_�_L Cw n(` SUSINESS(AGENCY &(-OOAA -- erQ <br /> ADDRESS c-c- –�—.��' C-R <br /> PHONE,, ( �o"ri K j; FAC52A11LE � " `I U ^-- <br /> TENTATIVI=`a PP DINT1,IFIiT DATE c nMz (OHO b <br /> (Plo :W 9:vo 7 to 10 bt acaS days from cyte r app)ioaaon submittal) :::��jh <br /> M ChECK BOX TO V;,F11r.,a ^tEQ4UE5':•578.00 Ftr.-fZZWE:ST?ROCE;.SSD IN 3 9USINESS DAYS <br /> SIGNATURE-OFAPPLICA:t1T �:>�.I"`� DATE <br /> ^FI:L RCS]F2E5$ THIS SIDE EHD STAFF USE ONLY <br /> PROGRAU ELEM@NTS ScAPCH <br /> v 7 ;)ALV: L L 1:),�� r c _. iI I J <br /> v � <br /> 6` <br /> ENVIRONMENTAL HEALTH DIVISION FUS JUL 1 2003 <br /> UKDERGA0UND'rANK ft;3:) .2LEANUP 317E(LOP) ❑ HOU51113 AEATE:'L:ENT ❑ SOLM WASTE FACUTY <br /> OTHER CLEANUP SI'r:(hlot� _OP) ❑ FOOD FACILITY i 5041p Y,'ASTE VEHICLE <br /> SUNrvZR6ROUNDTANK;f,IONItOR1!,* kUOVAL) ❑ 0013 KENNEL u 2AIRY <br /> C f2A«ARDOUS WASTE:GI_NEi.A,70A G CIt10K-EN RAN CM J PK3 TREATMENT PLANT <br /> ��T X250°cR151I7TFD".0.0-Lri M &IOTFL1iC1rEL C Ptah;?ER TRUCKJYARDFCKEMT01LETS <br /> TATTOO.'SODY PitIRCING POC"FA n LAND VST;APPLICATION S= <br /> ❑ MEDIC:L IVASTE FAC:I-JTY PUBLIC WATER 5'f5 T E:AI 1= OTHcR(PLEASE SPSCIFY ABOVE) <br /> 1. List up to ten adcress:s In the space above. Select tle type(s)of f4ras from the list above by checking <br /> trio approp-tate b:,x(eas). A,Ieast one He type MUST be seiected. Fax to 12091 464.0,138 or mail to the <br /> dre5_ ld!Catec.abov_°; <br /> 2. EK0 will rati:.;r tele 2P;16-1-ant If any EHD n?as exist. A apcointrncnt for review will be confirmed <br /> apptoxirnatet.1 fiva bu,-.inass days but no later than ten(10)days after receipt of application. The,fiies <br /> will be held for a 11axlrnurn of five b"Iness days for review. Appoirtmonts should be 3cheduied <br /> accordingl;l. <br /> 3. A file that ir,a wiv.aly b ellig worked on by EHO staff may not be immediately available for revlew. A new <br /> application may I:e submitted when the file is availab�a. <br /> 4. Any fire nct roturtled in the sane canditicto as released will be reorganized by END Staff at the OXpense <br /> of the applicant ;=utul•e file reviews by the same applicant may require a;76.00 deposit prior to review, <br /> 5. *TENTATIVE appuintnent dates must 49 confirmed with ELM staff. <br /> 6. Applicatlor4 received after 3:00 pm win be processes:the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CON' PHONE FAX INITIALS <br /> REVIEWED YES NO RIFF—VIEW DATE <br /> TOTAL P.01 <br /> Td WdSO:b0 £00Z Zu3 ';of2886 828 60E ON ONOHd s t sh i Pud o iaZ puno ir0 Wpd� <br />