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FUG 29 03 11:30a Karen Fitzmaurice G18-437-5731 P•3 <br />U8.'" i%<^ 17`J5 1,µ,p1 ��t `' n J6JU1 EN%JIRQllHENT .L HEAL PAGE 01 <br />DATE RECEIVEDII 1)I�I"� ` EHD LOG NUMBEP. <br />SAN JOAQUIN COUNTY <br />AUG 2 9 2003 ENVIRONMENTAL HEALTH DEPARTMENT I <br />�:1�NMEN7 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br />PERMIT/ENT h 468-3420 Fax: (209) 464-0138 Web: vvww.co.sanjcaquin.ca us/ehd I <br />_ PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: K a rrr en r'II -) 7 0,LA h U BUSINESSIAGENCY: $ T� <br />ADDRESS: / 1401f M Q?4. —I A l u- lo -24(4(o kp <br />PHONE: llZ�p0—143 --S-73S FACSIMILE: �10 —L4 3-�-- 5-731 <br />TENTATIVE' APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT _ DATE <br />Department Use Only <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />I)Y TANK (USTI CLEANUP SITE (LOP) <br />rid' HOUSING ABATEMENT <br />NDERGROUND <br />N9THER CLEANUP SITE (NON -LOP) <br />ADDRESSFILE <br />m/4NDERGROUND TANK (MONITORING02EMOVAL) <br />❑ DOG KENNEL <br />M -CHICKEN RANCH <br />M__/jjz�AR�DOUS WASTE GENERATOR <br />UY I ERED PERMITTED FACILITY <br />❑ MOTEUHOTEL <br />❑ 77ATTOOI6ODY PIERCING <br />❑ POOUSPA <br />13 OTHER (PLEASE SPEC <br />IVMEDICAL WASTE FACILITY <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />I)Y TANK (USTI CLEANUP SITE (LOP) <br />rid' HOUSING ABATEMENT <br />NDERGROUND <br />N9THER CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITY <br />m/4NDERGROUND TANK (MONITORING02EMOVAL) <br />❑ DOG KENNEL <br />M -CHICKEN RANCH <br />M__/jjz�AR�DOUS WASTE GENERATOR <br />UY I ERED PERMITTED FACILITY <br />❑ MOTEUHOTEL <br />❑ 77ATTOOI6ODY PIERCING <br />❑ POOUSPA <br />13 OTHER (PLEASE SPEC <br />IVMEDICAL WASTE FACILITY <br />UNIT <br />❑ Unit 1 <br />f <br />2 <br />3t 4 <br />Unit 5 <br />-fJ <br />LID WASTE FACILITY <br />OLID WASTE vEHICLE <br />O DAIRY <br />19"PKG TREATMENT PLANT <br />®��l1MPER TRUCK/YARWCHEM TOILETS <br />Er LAND USE APPLICATION SITES <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 later 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 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 $93.00 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 <br />DATE CONFIRMED <br />REVIEWED YES <br />TIME <br />PHONE FAX INITIALS <br />NO REVIEW DATE <br />RUG -22-2003 FRI 11:51HM ID: PAGE: -C <br />