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09/17/2003 09:07 FAX 209 9480621 U003/004 <br /> l7 BOG NUMOER <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> SEP 17 2003 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIR NT HEALTH (209)4683420 <br /> PERMi4IT/1TISER�'ICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT ��t +J SWLlri� BUSINESSIAGENCY I <br /> ADDRESS 7r7)2L E <br /> PHONE 70q—'TgE2-1S �'I S FACSIMILE ay —C! L/S)�O Fi rZ I <br /> TENTATIVE'APPOINTMENT DATE q I zg-.I0 3 TIME <br /> (Please elve T to 10 h Innes days from date of application wbmltW) �- <br /> 1 <br /> CHECK BOX TO FXPEDfT.E REQUEST-587.00 FEE- QUEST PROCESS ]BUSINESS DAYS 1 `7 <br /> SIGNATURE OF APPLICANT DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENT�„SFA(ZCHa <br /> �,S <br /> . S-1-0 ova <br /> 'SRo <br /> 40-11D NW <br /> 1j <br /> L-1546 <br /> . ct o,.t wa <br /> ti OO 0 txSM 0 2V <br /> LD .SHOD AJF iN `c <br /> I, <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1}4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT C9 SOLID WASTE FACILITY <br /> IR OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 9t UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL )RJ DAIRY <br /> M HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACKITY ' ❑ MOTELIHOTEL ❑ PUMPERTRUcWARDICHEMTOiLETS <br /> ❑ YATTOCIBODY PEIRCING ❑'POOLIsm -- 71t LAND USE APPLICATION SITES <br /> 0 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(east one rile type MUST be selected. Fax to (209) 464-0138 or mall to the <br /> address indicated above- <br /> 2. <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 he 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 he 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 $87.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will he processed the next business day, <br /> CONFIRMED APPOINTMENT DATE TIME.- <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />