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03/25/2004 17:49 4159699934 ENVSF L �ootf PAGE 02 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'Floor Stockton CA 95205 <br /> ENVIRUNIV1E J I i1EA4h9 : www.co.san-joaquin.ca.us/ehd <br /> )468-3420 Fax: (209)464-0138 Webi <br /> PERMIT/SERVICES I <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> n �y /J <br /> APPLICANT: BUSINE SIAGENCY: /(/ V ! V r le/ c1 Ink <br /> ADDRESS: <br /> PHONE:_(� 'I y)�`GR FACSIMILE: /(x6i/.� <br /> TENTATIVE'APPOINTMCNT DATC: 5� < <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00�/FFEE-REQ/UF5T PROC SSED IN BUSINESS DAYS 3 <br /> 31ONATURE OF APPLICANT i. "ee-Zt.- ��. DATE <br /> Department Use Only <br /> FILE ADDRESS UNfT <br /> Lt a <br /> E a (_ ❑ Unit 1 <br /> a. l( `Y( a T ❑ Unit 2 Li <br /> er -Jv I <br /> 5. 2n C o dad <br /> s a Q ci a S Unit 3 <br /> O _ e] c ✓./ ag nit4 <br /> e. etre a15t 0 ab <br /> D. a ex Oy / otyUnit 5 <br /> 10. a Vt �V71 ✓I T- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES L <br /> O'LINDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑,/OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY D SOUP WASTE VEHICLE <br /> rO 11NDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL Cl DAIRY <br /> ❑ HA2ARDOVS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIFRED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOO/GODY PirRCINC 1`1 POOUSPA ❑ 1 APin ILSF APPI ICATION RrTrA <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up t0 ten addresses In the space above. Select the type(s)of files from the list aboveby checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209146 38 <br /> or=e to the <br /> address indicated above. <br /> 2. FHn 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 FHD 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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD4442-0 <br /> EaR007 <br />