Laserfiche WebLink
044 07! 2001_C. Ct ll11 sa AGE STDCKTDN <br />(— I .U1N COUNTYPUBLIC HEALTH S /ICES <br />APR 0 7-2003' <br />ENVIRONMENTAL EENUE, HEALTH <br />FLOOR f <br />ENVIRONMENT HEALTH STOCKTON CA 95202 <br />(209) 468-3420 <br />PERMIT/SERV <br />LIC RECORDS RELEASE APPLICATION <br />APPLICANT <br />ADDRESS <br />PHONE _ C;Dq J 96 A <br />TENTATIVE* APPOINTMENT DATE!''^ <br />(Please give 7 to 10 <br />CHECK BOX TO EXPEDITE RE <br />SIGNATURE OF APPLICANT <br />PAGE 01/01 <br />£NO LOG NUMBER <br />BUSINESS/AGENCY (� �' �) L' <br />- . - - - ..� -a _.._._ <br />FACSIMILE <br />FEE — <br />days from data <br />FILE ADDRESS <br />I&L -Irlia � rlD <br />TIME _rt _ X1-10 <br />applicatlon submittal) <br />ED IN 3 DUSINESS DAYS 1 <br />t DATE zm�_ <br />lz <br />L/ n 11h, A :1 • _ <br />- W, <br />d <br />is ®• et ♦ - <br />7 A1 <br />ENVIRONMENTAL. HEALTH DIVISION FILE <br />APR 10 2003 <br />UNDERGROUND TANK (U5T) CLEANUP SITE (LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br />HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY O MOT91JHOTEL O PUMPER TRU(;KIYARD/CHEM TOILETS <br />O TATTOO/BODY PEIRCING O POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHI_R (PLEASE SPECIFY ABOVE) <br />1. list up to ten addresses in the space above. Select the type(s) of files Prom the list above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (209 464-0138 or mail to the <br />address Indicated above <br />2. EHD will notify We 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 of application. The filos, <br />will be held for a maximum of five 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 now <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 EHD staff at the expense <br />of the applicant. Future file reviews by the same applicant may require a $78.00 dr!posit prior.to review. <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 clay. <br />.71 <br />CONFIRMED -APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />