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03/26/2003 11:37 2094671118 AGE STOCKTON PAGE 01/01 <br /> PATE IMOEIVIZII, <br /> 110 LOG NUM15FR <br /> 6AN, AQUIN COUNTYPUBLIC HEALTH t..eVICES ' <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 2 6 2003 30.4 EAST WEBER AVENUE,THIRD FLOOR <br /> . STOCKTON CA 95202 <br /> TH (209)463-3420 <br /> rii�i;i;13,1.-P,\�,lgul3LI..C.-'RECORDS RELEASE APPLICATION <br /> APPLICANT BUSINESSIAGIENCY A&W <br /> ADDREssdefryL eig <br /> PHONE C�0i?) 9&17- /1Xb FACSIMILE 9) Yb 9- LtA-� P! I'M <br /> ORC <br /> TENTATIVE*APPOINTMENT DATE�_„A-1() ) TIME, � et'�D <br /> (Please give 7 to III business days from date Of application submittal) <br /> ,� ; CHECK BOX' TO EXPEDrTE REQLRS-r -$1114.00 FEE-REQUEST PROCESSED IN 313USINr-S,4;MVIS u Y r <br /> SIGNATURE OF APPLICANT 11�k DAT <br /> FILE ADDRESS <br /> % <br /> wy.q T- <br /> L f) <br /> L - <br /> A A),D,& I.A I _),,,7,- <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(t-OP) tl HOUSING A13ATEMP-NT El SQ[-ID WASTCT ACIUTY <br /> N "-F <br /> Up_ <br /> OTHER CLEANUP SITE(NON-LOP) U FOOD FACILITY Cl 501-ID WAST F:1 EHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIPY <br /> D <br /> 0 CHICKEN RANCH EI PKC TREATMENT PLANT <br /> t,_rtM E -M TOILE-'.TS <br /> TIERED PFUMITTIED FACILITY 0 MOTELMOTEL 13 PUMPER TRUC14NARDICHE <br /> TATTOC11BODY PEIRCING 13 POOL SPA 0 LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACiLrry ED PUBLIC WATER SYSTEM EJ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the 1h.- above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209) 4(A..01 38 or mail to lh* <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 ol'application. The files <br /> will be hold for a maximum of five business days for review. Appointments shc i It], be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately avalla le 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 E aT <br /> . v 1 00 <br /> of the applicant. Future file reviews by the same applicant may require.0 $79.0(.El.ikcl uaa:�61 11 <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 01103100 <br />