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U9/17/2003 09:37 FAX 209 9480621 <br /> JL10 005/004IU" SAN J A U �.` <br /> EM NUMBER <br /> 4 IN COUNTYPUBLIC HEALTH SERVICES E <br /> SEP 1 7 2003 ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> E NVIR0[*AEN-I' HEAL(H 5TOCKTON CA 95202 qqn5 <br /> PERMIT/SERVICES (20S)4ss�20 <br /> �/ PUBLIC RECORDS RELEASE •APPLICATION <br /> APPLICANT f—n BUSINESS/AGENCY <br /> ADDRESS %)21 F 1H� - �f CI�C�C -1�iAt �' 4 q —z-o 5�— <br /> PHONE 5F S FACSIMILE L/7)~Q 62. I <br /> TENTATIVE*APPOINTMENT DATE _ q/2aLi o •nmi: 12.%CTJ <br /> (Please give 7 to 10 b i�day*from date of application submittal) r39 <br /> CHECK BOX TO EXPEDITE REQUEST-387.00 FEE— QUEST PROCESS"3 BUSINESS DAYS <br /> SIGNATURE_OF APPLICANT -- DATE <br /> 1 <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> it <br /> rvi <br /> 0 1 h C N w 9 S lei CK-4--o'i CA <br /> Al <br /> Sob M. W <br /> a0 U Mz_ <br /> c7 <br /> 9 v Go sA00 4Ob—I�n <br /> l 4 .0 gAbaftim 11 <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> q UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 11 SOLID WASTE FAC LITY <br /> IR•OTHER CLEANUP SITE(NON-LOP) C] FOOD FACILITY ❑ SOM WASTE VEHICLE <br /> 9t UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL M DAIRY <br /> I8 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> Cl TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 13 PUMPER TRUGiCIYARDICHEM TOILETS <br /> U TATTOOMODY PEIRCING ❑•P'd0UsPA "' ' W LAND USE APPLICATION SITES <br /> Q MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFYABOVE) <br /> 1. 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 file type MUST be selected. 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 appointment for review will be confirmed. <br /> approximately five business days but no tater than ten(10)days after receipt of application. The files <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 new <br /> application may be submitted when the file is available. <br /> 4. Any file not returned In the sante condition as released will be reorganlzed•by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$B7.00 deposit 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 day. <br /> CONFIRMED APPOINTMENT DATE TIME.' <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> R1=1/IEWED YES NO REVIEW DATE <br />