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03/25/2004 17:49 4159899934 <br /> n I � ENVSF vlf PAGE 02 <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRUNNdEidi HEN304 E Weber Ave V Floor Stockton, CA 95205 <br /> S9)468-3420 Fax: (209)464-0138 <br /> PERMIT/SERVICEWcb: www.cO.san-jDaquin,ca.us/ehd <br /> I'll I PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��( RUSINE SIAGENCY:_�✓ /�f/]J�C.. � <br /> ADDRESS: `�r�"( f r"O �i° <br /> PHONE:_( "? �-GR3�, <br /> � FACSIMILE: <br /> TENTATIVE*APPOINTMDNT DATc: <br /> Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-190.00 FEE—REQ/UUFF,��T PROCESSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 3 <br /> I DATE <br /> Department Use Only <br /> FILE ADDRESS UNrr <br /> Sncel ( H Ef o �O D 14 <br /> a CI <br /> sl 2 u L ❑ Unit 1 <br /> u <br /> s. Bp `bl r ❑ Unit 211 <br /> C 5 nay <br /> s s Q cl <br /> e eae <br /> � �g nit4 <br /> B. 8 eaf D <br /> a <br /> G <br /> ,o. s - `fit .a000 (7 = Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ("UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> E-UNDERGROUND TANK(MONITORINWReMOVAL) ❑ DOG K!NNEL <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 12DAIRY <br /> TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ IdOTELlNOTEL C3TATTOOMODY PIGRCINO PUMPER TRUCK/YARD(CHEM TOILETS <br /> ❑ MEDICAL WASTE FACILITY r1 POOUSPA ❑ I ANn IISF AVPI ICATION RITES <br /> ❑ OTHER(PLEASE SPECIFY) <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(2091464.0138 or mail to the <br /> address indicated above. <br /> 2. FHn will Intify the applicant if any EHD Hiles 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 fifes <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 /> S• *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S• Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE .__ TIME <br /> [REVIEWED <br /> ATE CONFIRMED PHONE FAX INITIALS <br /> YES NO REVIEW DATE <br /> EXD�r-0].006 <br /> &NSOOd <br />