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Ru ��20Q4.12 37PM NO' �NU[RO 209 . 369 .4228 N o , 6 2 3 8 P . 2 <br /> r \ t - enu 4OG NumbeR <br /> ��{� '_�I`���� I�AN Jt„,.aUIN COUNTYPUBLIC HEALTH SER..�ES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> AUG 2 5 2004 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONNIEi`4T HEALTH (209)4W-=0- 1 70 <br /> PERMiT,1SF--5 jj ;F.g PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT ����G\ ,8US1NE. S/AGENCY 'Ve-1l �SSFGICt �s <br /> ADDRESS_ 902- Z rk845+rja1 \90.y Lod \ c c 2LYQ <br /> PHONE 2-O l l-G_ l FACSI1111LE � <br /> TENTATIVE'APPOINTMENT DATE TIME e <br /> (Ptoare give 7 to i0 businoca days from date of application wbmittzt) , ?? <br /> Up <br /> CHECK BOX TO EXPEDITE REQUEST-$89.00F Qt(lEST P SSGD IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE d jt� <br /> TH13 SIDE ELLE ADORE53 O STAFF USE ONLY <br /> S -S30 PROGRAMHELEMENTS SEARCH <br /> P)44h r n c •Lk a <br /> Lo iS�,'c <br /> e <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ��SOUD WASTE FACILITY <br /> HER CLEANUP SITE(NON-LOP) ❑ FOOD FAdLITY 0 SOLID WASTE VEHICLE <br /> DEROROOND TANK(MONITORINO/REMOVAL) ❑ DOG KENNEL M DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKO TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY CI MOTEL/HOTEL ❑ PUMPER TRUCKIYARDIC 4EM TOILETS <br /> O TATTOO/BODY PEIRCING M POOLISPA I3 LAND USE APPLICATION SITES <br /> 13 M IDICAL WASTE FACILITY d PUBUC WATER SYSTEM O OTHER(PLEASE SPECIFYA80VE) <br /> I. 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 filo typo MUST bo eoioctod. 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 appointmont 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 fire 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 whon tho filo is available. <br /> 4. Any file not returned in the same condition as released will be roorganized 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 2pp0lntmvnt datos 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 INITIALS <br /> REVIEWED YES_ NO REVIEW DATE <br />