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03/26/2003 11:37 2094671118 AGE STOCKTON PAGE 01/01 <br /> DATE RECEWCa-, -1 1-- <br /> [7 610 LOG NUMBER <br /> AQUIN COUNTYPUBLIC HEALTH ��VICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR 6 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> (209)468-3420 <br /> 4"qIF.ki'3 HCOLIC RECORDS RELEASE APPLICATION' <br /> APPLICANT ( BUS.INESSIAGENCY OAMd * .1cm—lo-19-1 <br /> ADDRESS 2317 ' SAO U) kAgj OP 95;Z'1-.r <br /> PHONE FACSIMII E <br /> TENTATIVE'APPOINTMENT DATE2)i TIME C ' <br /> (Please give 7 to 16 business days from date of applicatlon submittal} r. <br /> ,X'C'HECK BOX, TO EXPEDITE REQS- 94 -EE S 00 r U <br /> -REQUEST PROCESSED IN 3 UUSINESc;DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS <br /> 46'� 0A k&.)k-NqN <br /> 7 1 <br /> 5 LI) 3IL21, <br /> \6SOD <br /> \1)Qt&C W. &W9 Mhl GX <br /> ENVIRONMENTAL HEALTH DIVISION FILE$ <br /> UNDERGROUND TANk(usT)-cLEANUO SrrE(Copj 0 HOUSING ABATEMENT n 501.10 WAS11!1:ACILITY <br /> S OTHER CLEANUP SITE(NON-LOP) 0 r-bOD FACILITY 0 501.11)WA-SIT:I,EHICLE <br /> TIERED <br /> ("ONYITORIN GIREM OVAL) 0 DOG KENNEL El DAIRY <br /> C3 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> E 17 PE <br /> =I,Mrr r <br /> _n r i IT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCI,YYARDICHF-FA T011-5TS <br /> 0 TATTOO/H0 I3Y PEIRC ING 11 FOOLISPA 0 LAND USE AFP ICATION SITES <br /> 0 MEDICAL WASTE rACILnY 0 PUBLIC WATER SYSTEM CJ OTHER(PLEAS E SPECIFY ASOVC) <br /> 1. List'up to ten addresses in the space above. Select the type($) of files from the list above by checking <br /> the appropriate box(es). At least one rile type MUST be selected. Fax to(2091 4(A,0138 or mail to the <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 (110)days after receipt of:ap plication. The files <br /> will be hold for a maximum of five business days for review. Appointments shcnild be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not beimmediatelyavalla 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 <br /> of the applicant. Future file reviews by the same applicant may require a$78.0iffe 10114 <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after <br /> ter 3;00 pm will be processed the next busines.,; day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX IN[l'ljkL.'.,; <br /> REVIEWED YES NO REVIEW DATE <br /> P14 00 14 61105m0 <br />