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-rr<Ln'1 : NOA Environmental PHONE NO. : 209 369 4228 Dec. 03 2002 02:54PM P2 <br /> WE HECENED e"Q Soc NWBM <br /> N'J AQUIN COUNTYPUBLIC HEALTH S RViCES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> D E� � 3 2OOZ V 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> STOCKTON CA 95202 <br /> W PCINMEN T I I[ACTH (209)468-3420 <br /> PFRPAIT/SFRVICRSIBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT 441381 F—AC-C-O BUSINESSIAGENCY 14UA- �Ny1�NIMENTA L• <br /> ADDRESS 7.7-- '�D Lits 1_U'N LJ� Lib I <br /> PHONE lyl1) FACSIMILE (7a9) 36M -47-2-? <br /> TENTATIVE`APPOINTMENT DATE I7-^ I2_^ 67.• TIME 10-•60 AVN. <br /> (Please give 7 to 10 business days from data Of application submittalI <br /> L I-oa days\) <br /> Lin <br /> T <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00 FEE-REQUEST PROCESSED IN 3 Lin�YS, <br /> SIGNATURE OF APPLICANT _�% -� DATE 1 z^7i OZ <br /> FILE ADDRESS .1"1- THIS SIDE EHD STAFF USE ONLY <br /> GM Lodi `15240 PROGRAM ELEMENTS SEARCH <br /> Y) <br /> 1 tread W <br /> l�✓• 120 ic�oi' I\ � �. <br /> g "CAW t } <br /> DO <br /> OZ CIS �. r <br /> ✓ li( E. C;4 <br /> 133 6. 'tVrrur Pa. ,:..r. <br /> ENVIRONMENTAL HEALTH DIVISION FILES 14� <br /> IRI UNDERGROUNb TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> tis OTHER CLEANUP SITE(NON-IAP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> i9 UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> M HAZARDOUS WASTE GENERATOR O CHICKEN RANCH 10 PKG TREATMENT PLANT <br /> VI TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM §t OTHER(PLEASE SPECIFY ABOVE) <br /> 1. 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 selected. Fax to(209) 464-0138 or mail to the <br /> address indicated above. <br /> 2. 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. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new <br /> application may be submitted when the Tile is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 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 />