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! !i <br /> Dec 08 04 02: 37p HanoverITnc 530- 342 -1490 t'. 2 <br /> LSA"ISl—[UtJvJ YJO r ru EKD LQt NU1dBF.ft <br /> QAieri€ �'ra i rl hl COUhiTYPUBLId HEALTH SEF�"ViCES <br /> % o�iC,�� '' A .lOAGtUI <br /> - - ENVIRONMENTAL HEA�.TH DIVISION <br /> 2004 304 EAST WN SF_R AVENUE.THIRD FLOOR <br /> DEC 8 STOCkTON CA 95202 <br /> (209)4$8-3420 <br /> OE 4 BL1C RECORDS RELEASE APPL1,CATION <br /> SOV' <br /> �� � 1C�;�. BUSIEIIESSlAGENCY _. <br /> AN <br /> APPLICT !� <br /> LAA <br /> ADDRESS IQ '- t'f ararcter Sl, JFG �• ! L,J <br /> FACSIMILE <br /> PHONE .s <br /> • TE:WE (� <br /> TENTATIVE*APPC1tNTMENT DATE «r 3 o� <br /> (Please glue 7 to i O;I usiness days from slate of appl;cetlor+suhrotttaE) <br /> CHECK BOX TO EXPEDRE REQUEST•$si.Oo FE a-REQUEST PROCE55E0 IN 3 BUSINESS DAYS <br /> 1 PATI; <br /> SIGNATURE OF APPLICANT <br /> IS SIDE EHD STAFF USE ONLY <br /> FILEADDgin ROO ELEMENTS SEARCH <br /> FCOP <br /> jqqfl� hi• A>7��rOs <br /> J k <br /> r A <br /> i <br /> Mh <br /> ys. <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> f!' E' !E <br /> l] HOUSINGABATEMENT 0 SOLID WASTE FACILITY <br /> f UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 FOOD NG ARTY U SOLID WASTE VEHICLE <br /> !� <br /> OTHER-CLEMUP SITE(NON-LOP)/ ❑ DAIRY <br /> C3!UNDERGROUND YANK(MONtTORINGIREMOVAL) "j0 DOG KENNEL p PKG TREATMENT PLANT <br /> tl HAZARDaus WASTE GENERATOR ❑ CHICKEN WINCH O PUMPER TRUCK(YARDICHEM TOILETS <br /> 0 TIERED PERMITTED FACILITY lU ryE0T5�f1107EL •• ❑ LAND USE APPLICATION Sr MS <br /> 0 TA'r r0013ODY PEIRCING " 1.40 POOIISPA ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 0 ItME:)ICAL WASTE FACILITY '© Pt16I.IC WATER SYSTEM <br /> 1. List up to ten addresses in the space above. Select the types}of.files from the list above by checking <br /> one file type MUST be selected. Fax to .9464-0138 r mai to the <br /> the appropriate box(es). At(east <br /> address indi afed alsav�e. Sij <br /> 2. -FHD wI1I 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 (90)days after receipt of application. The files <br /> wi"( be helot for a maximum of five b6sihess days for review. AppointmOnts 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 file is available. <br /> 4. Any fiw not returned In the same condition-as released will be reorganized by EHD staff at the expense <br /> of the applicant. f=uture file reviews by'the some applicant may require a $87.00 deposit prior to review. <br /> 5. *TENTA'i,jVE appointment dates must be confirmed with END staff. <br /> 6 Applicati��ns received after 3:00 pm will be processed the next business day. <br /> f <br /> CONFIRMED APPOWITMENT IJATE TIME <br /> BATE CONFIRMED _ : PHONE FAX• INITIALS <br /> REVIEWED YES <br /> . NO! REVIEW DATE <br /> IPI DP 14 DF.IW QP s <br /> .. ;'' T©TPL P-01... <br />