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09/02/2003 07:32 55926877.26 TWINING LABS PAGE 01/0 <br /> 10-17-2080 1 FF <br /> i�vt' t�nIIq TO 1.5592687126 P.02 <br /> .moi\T,E3lr 7D �, <br /> ��L✓ --.IIA AN JOAQUINCOUNTYPUBLIC HEALTH SERVICES 6NUlUc:htUMiILH <br /> SEP Q 2 2003 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WESER AVENUE,THIRD FLOOR <br /> STOCKTON CA 9=02 <br /> ENVIRuivivIENT HEALTH (209) 468-3420 Zo5- L( C, �(- <br /> -- PES"JI1;/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> s <br /> APPLICANT S BUSINESWAGENCY <br /> �. <br /> ADDRESS 2 % �f�Y "� �- <br /> pHONE_��� <c^- 771 <br /> FACSIMILnEAP <br /> ,{l <br /> TENTATIVE*APPOINTMENT DATE <br /> (Please _ TIME <br /> ( give 7 to 1 o business days from date of applfcat;on submittal) <br /> CHECK BOX TO EXPE=DITE R1;QUEST_,587 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��� '- ^JJ� <br /> DATE <br /> FILE ADDRESS THIS SWE EHD STAFF U5E ONLY <br /> \ PROGRAM ELEMENTS SEARCH <br /> V C C1 - <br /> �l <br /> n � <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 3�'UNOERGROUND TANK(UST)CI,E NUP 51TE(LOF) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FAC4UTY ❑ SOLID WASTE VEHICLE <br /> ,2�UNOERGRGUNC TANK(Id ONITOR)lYGfREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> 'PHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH O PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ NOTELIHOTEL E3 PUMPER TRtJCK1YARIlICFiEM TOILETS <br /> MEDICAL <br /> C Mt30DY PEIRGiNG C] POOUSPA D LAND USE APPLICATION sans <br /> G EDICAL WAST£fAC11JTY ❑ PUBLIC WATER SYSTEM! 17 OTHFA(PLEASE SPECIFY ABOVE) <br /> 11 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 Selectod. Fnx to 209 4 <br /> �dXe�s ingitat�fi ve <br /> 2. EHD will notify the applicant if any EHD tiles 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 maxlmum 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 bo immediately avallable for review, A new <br /> Qpplicatlon may be submitted when the file is available. <br /> 4, Any file not returned in the same condition as released will ba reorganlzed by EN 5teff at the expense <br /> of the applicant. Futuro file reviews by the same appliCAnt may require a $87.00 deposit prior to review, <br /> 4- "TENTATIVE appointment dates must be confirmed with END staff, <br /> 6. Applications received after 3.00 pm will be processed the next business day. <br /> I <br /> 4 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> II ---------------- <br /> PA76 �pNFIRMEp PHONE FAX INITIALS <br /> EVIEWED YES NO RI:YIEW DATE <br /> ae 14 ayorao <br /> i <br /> TDTFIL. F.02 <br />