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03/26/2003 11:37 2094671.118 AGE STOCKTON PAGE Q11/01 <br /> DATE RECEIVIZ,4_,,, 60 LOG NUMBER <br /> -- RVICES <br /> W.—LAQUIN COUNTYPUBLIC HEALTHt.�� <br /> V_'. —.- ENVIRONMENTAL HEALTH DIVISION <br /> MAR 2, 6 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209) 468-3420 <br /> 13LIC RECORDS RELEASE APPLICATION <br /> dAPPLICANT BUSINESS/AGENCY <br /> r7 <br /> ADDRESS a 4) 09 19? <br /> PHONE 910 - - FACSIMILE WAa____ In I N 6_!!� <br /> TENTATIVE*APPOINTMENT DATE 1 TIME PI�2C) <br /> (Please give 7 to 1h business days from date of applicatlon submtttal) <br /> 't-ICCHECK BOX TO EXPEDITE REQ ST-04.00 FEE—REQUEST PROCESSED IN 3 SUSINrS!;DAYS U <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> i!A=M <br /> 1 7, <br /> AA i— <br /> vht 1:7 <br /> 5 KIL <br /> \)hl A) <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOU51NO ABATEMENT 0 SOLID WASTI'l ACfLITY <br /> P I <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WAS11'. HICLE <br /> _ _ 0 U N <br /> N G <br /> UNDERGROUND TANK(MONITORIN [REMOVAL) CI DOG KENNEL CI DAIRY <br /> ��� Q CHICKEN RANCH EI PKGi TREATMENT PLANT <br /> ) _ 1: IT TS <br /> TIERED PERMITTED FACILITY 0 MOTEL[HOTEL 0 PUMPER TRUCIVYARDICHEM TOILE: <br /> 0 TATTOOtBODYPF-IRCING Q POOLJSPA El LA14D USE APP (CATION SITES <br /> C3 MEDICAL WASTE FACILITY 0 PUBLIC WATER SYSTEM El OTHER(PLEASE SPECIFY ABOVE) <br /> 11 List up to ten addresses in the space above. Select the type($) of files from the Ill- above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fa);to(209) 444 0138 or mail tO IhO <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for ravieW will be confirmed <br /> approximately five business days but no later than ten (10) days after receipt of alplication. The files <br /> will be hold for a maximum of five business days for review. Appointments shvUld be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately avallalle for review. A new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by Ef <br /> of the applicant. Future(lie reviews by the same applicant may require $78-0C ifoo!5314 <br /> 5. *TENTATIVE appointment dates must be COnfirmed with EHD staff. <br /> 6. Applications received after 3.00 pm will be processed the next business'day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIAL'.',� <br /> REVIEWED YES NO REVIEW DATE <br /> E14 00 14 0110S*Q <br />