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`-'rO�P-111-03 (1�3::4//3 From-TTI TETRI H EM INC +9168520307 �. T-50T P.02/03 F-803 <br /> FlIE CIV` ) qAN J AQUIN COUNTYPUBi-.IC HEALTH SERVICES L4 Lu.a 71VlNV H• <br /> SEP 1 1 2003 i ENVIRONMENTAL HEALTH DIVISION <br /> 301 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209) 458-U24 <br /> ERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ZA&M"' r'Ah SAc h <br /> APPLICANT sUS1NESSINESS�A NGY <br /> ADDRESS /06 h/ O /OO �airtC.yt o ( p cjo <br /> PHONE_ 9I(0- FACSlA4Jl E 1 D ^ 0 30 <br /> TENTATIVE"APPOINTMENT DATE TIME r <br /> (PICaSC give 7 to 10 ousinCSs pays quo Of applscaGon auamivaq <br /> CriEGK 80X TO EXPEDITE IREQaE587.00 Fl=E—RE ST PROCESSED IN 3 DL►SINESS QAYS �� �SIGNATURE OFAPPI-iCANT ,,L DATE lc' 1 <br /> 3 --- <br /> F 1 E AAQRESS THIS SIDE EHD STAFF PSE ONLY <br /> PRPGRAM ELEMENTS SF-ARCh <br /> OYl <br /> c <br /> I <br /> ENVIRONMENTAL-HEALTH DIVISION FIl-FES <br /> UNDERGROUND TANK(USTQ CLEANUP SITE(LOP) 0 MOUSING ABATF.MFNT �soup WAs FACILITY <br /> OTHER CLEANUP SITE(NON',LOP) ❑ FOOD FACILITY SOWP WASTE VEHICL-E <br /> UNP911GROuND TANK(MONITOMNGtREMOVAI.) Q DOG KF.NNF-I- ❑ QAIRY <br /> KAZARDOUS WASTE GENERATOR ❑ GriICKEN RANCH ra'PKG TREAtMANT PLANT <br /> 4 TIERED PERMr1TED FACIWT7 r D MOTELIHOTEL ❑ PUMPER TRUCKfYARQICHEM TOI49r, <br /> CI TATTOOISOPY PI=IRCING ❑ POOLjsPA - - o LAND USE APPLICATION anEs <br /> Q MEDICAL.WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q OTHER(Pl_WE SPEt:IFY AsovF.) <br /> 1. List up to ten adQresses in the space above. Select the types) of files from the list.above by checkil <br /> the appropriate 6ox(es). At least one file Type MUST be selected. Fax to (209) 464-0139 or mail to thi _M) <br /> pdoress indicated ,4bove. <br /> r <br /> 2. EMD will notify toe appliCant if any EMD files exist. An appointment for review will be confirmed <br /> approximately five quslness days but no later than ten (10) days after receipt of application.-The file <br /> will be nelb for almaximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively peing worked on by ENp staff may not be immediately available for review. A n <br /> application may pe submitted wh®n Me!file is availatile. <br /> 4. Any file not rcturnaq in the"me condition as relea3ca will be reorganized ay FHP staff at the expel, <br /> of Me applicant.:Future file reviews by the same applicant may require a$47.00 deposit prior to nevi, <br /> �- •TENTATIVE appointment Batas must be confirmed with EHO staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> wqwh 0 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE: CONFIRMED PHONE FAX INITIALS <br /> pcv�F� ren ..r � .... __...---.. - <br /> t,61f U,117 -P�/'rC6�� -, t 3 <br />