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p-i1-03 13::4�]3 From-TTI TEM A EM INC +9168520307 � T-507 P-02/03 F-803 <br /> F0 USAN JUAQuIN COUNTYPUBLIC HEALTH SERVICES L :Lina 7lv�nuH• <br /> ENVIRONMENTAL H1=ALTH DIVISION <br /> SEP 1 1 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209)468-i24 <br /> ERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> r21 h SlrNsa LS'r,..cq h -r-0, <br /> APPLICANT l3LISINESS'A NCY I {/1 <br /> ADDRE54 �QCC� Q h/ O /00 �'+c�►o �o c�oc n✓ft 9STv ; <br /> PRONE <��' U� -� .�0 FACSIMILE ! D <br /> TENTATIVE"APPOINTMENT BATE <br /> (Please diva�to 90 pasincss pays Ga[G of pppliCaGon auamival) <br /> 77 <br /> X CHECK BOX TO EXPEDITE 1REcIUE 567.00 FEE-RE ST PROCESSED IN 3 BUSINESS DAYS �� `,1, Y <br /> � <br /> SIGNATURI- OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHA STAFF PSE ONLY <br /> PROGRAM EL.EMENTS.SF_ARG11 <br /> Of7 <br /> c <br /> i <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES _ "'- <br /> ir <br /> UNCIERGROUNO TANK(USTQ CLEANUP SITE(L-OP) 0 nQUSING ABATEMENT SOLID)WAS FACIU-rY <br /> OTHER CLEANUP SITE(NON�IAP) O FOOL)FACILITY SOUR WASTE VMCLE <br /> UNDERGROUND TANK(MOt4lTOR1NGIREMOVAL) O DOG KENNEL. O DAIRY <br /> HAxARpOUS WASTE GENE _ TOR d CHICKEN RANCH rG FKG TREATMZNT PLANT <br /> Q TIERED PERMITTI=P FACILITY ❑ MOTELIHOTEL C7 PUMPER TRUCKMAROICHEM TOIL-I': <br /> 0 TATTOOISODY PkIRCING a POOWSPA - • ❑ LAND user APPLICATioN sans <br /> n MEDICAL.WASTE FACILITY ❑ PUBLIC WATER SYSTEM Q OTHER(PLEASE SPECIFY ABOVE) <br /> Z. List up to ten addresses in the space above. Select trio types)of files from the list.above by checkil <br /> the appropriate Oox(es). At least one fife Type MUST be selected. Fax to(209) 464-0130or mail to I) i <br /> pdgress indicated above. n <br /> r <br /> 2- EHp will notify tlpe applicant if any EMD fllos exist- An appointment for review will be confirmed <br /> approximately five gllsiness days but no later than ten (10) days after receipt of application. The file <br /> will be held for almaximum of five business days for review- Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively Doing worke:a on by EHD staff may not be immediately available for review.'A n <br /> application may pe submitteo when the file is availaple. <br /> 4. Any file not returneo in the Ss3me condition as released will be reorganized ny EHD staff at the expen <br /> of the applicant, FuturC file reviews by the same applicant may require a U7.00 aeposlt prior to revi, <br /> 5. 'TENTATIVE appointment dates must be confirmed with ENA staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CON�1RM p APPOINTMENT DATE <br /> TIME <br /> DATE_ CONFIRMED PHONE FAX INITIAL$ <br /> pC�/�F�nr�n yr .... ------• . <br />