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FROM Uround Zero Analysis 0 PHONE NO. : 209 838 9883 Mar. 05 2002 09:19AM P1 <br /> ill.Xkt:kNBU <br /> 1G LGu xu%+ae�! <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH S1~RVICES# <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EASE'WEBER AVENUE THIRD FLOOR <br /> r` STOCKTON CA 95202 <br /> (209)468.3420 7?10 <br /> —5 -' 10:02LIC RECORDS RELEASE APPLICATION <br /> v <br /> AFFLICANT Cb �� �� . 9u9 <br /> rt1NESS1A13ENGY C—,1)a 2k&A j 2C,'Z YI-�CQ SI LkQa <br /> ADDRESS (-7(q9 E /W.�✓� `<�� C-�. ��C9Vl_ (��3 <br /> PHONE$ r U PACSth1N.E :7 y 'T V <br /> TENTATIVE'APPOINTMENT DATE 7 <br /> (PI sa vo 7 t '10� days fr to of apD'cation yabrnittall <br /> 1.M CHECK 8OX TO EXPED1'7E REQUIUS1. 78.00 F �S ED l SiNE3S DAYS <br /> BU <br /> SIGNATURE OF APPLICANT ` "' T� DATE � ��-- <br /> FILL'ADDRESS THIS SIDE El;STAFF USE ONLY O <br /> PROGRAM ELtmg=WARCH <br /> \ 3'T thOV` S C. <br /> �I c- <br /> 1 <br /> nn 97 P rr <br /> 41 <br /> 00 <br /> ` ENVIRONMENTAL HEALTH DIVISION FIL1=S <br /> PrVyN.pERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ ROUSING ABATEMENT ',D SQL:D WASTE FACILITY <br /> �� PTklER CLEANUP SITE(NON-LOP) Q FOOD rACILr Y Q SOLID WASTE VEHICLE <br /> SiUINDERGROUN0 TANK;MONITORING1MMOVA1.) 0 DOG YgNNEL Q DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH D PKG t'MATMENT PLANT <br /> 0 TIERED PERMJMD FACILITY 0 MOTt &HOTEL ❑ PUMPER TKUCK/YARD/CHEM TGILETS <br /> 4 TATTOO180by Pe1RCING 0 PCIOLMFA 17 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACT-ITY 0 PUBLIC WATER SYSTFIA 0 OTHER(PLEASE SPCCIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by chaciting <br /> the appropriate box(es), At least one file type MUST be selected. Fax to f2Qg)464-Q•138 or mall Lo-the <br /> gjddrgs5 indicat SLg ova. <br /> 2. EHD will notify the applicant if any EHD files exist. An appolntment for review will be confirmed <br /> approximately five businoss days but no later than ter?(10)days after r•eaeipt of application. The files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> J. A file that is actively boing woritod on by EHD staff may not be irilr ediataiy available for review. A new <br /> application may he submitted when the fila is ava3lablo, <br /> 4. Any file not roturned in the carne condition ras relea3td will be reorganized by EHO staff attne expense <br /> of the applicant. Future file reviews by th@ same applicant may require a$78:00 deposit prior to review_ <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications meoived after 3:00 pm will be processes}the next business day. <br /> CONFIRMED APPOINTMENT DATE _ -- TIME ' <br /> ` DATE CONFIRMED PHONE FAX INITIALS <br /> 1 <br /> REVIEWED YES NO REVIEW DATE <br /> Q44 U 02r-AMP <br /> TOTAL F.0i <br />