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\ �TERRLRCON - RENO Fax:775-351-2423 Nov 4 2qQ; 13:47 P. 01 <br /> V D iPlit �I�EFP��`��;IiL �) • <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> _NVIRUNMEI'J Q�P1,E45$-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca-us/ehd <br /> PERh4117SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ IM[rrFCE BUSINCSS/AGENCY:__L AC_0&) <br /> ADDRESS: 3 8 G(ZF_6 <br /> PHONA• -TI -2404 u �r <br /> Gam OTIS,-,7.50` t FACSIMILE: —ISS-3.� -ZVZ3 <br /> TMENT DATE: t=sah fJ oy tj Time; oZ�� <br /> (Please allow 10 business days from date of application submittal) <br /> ' <br /> L� <br /> �/CHEC K BOx T� hRCA�aO <br /> CO EXPEO QUEST-$93.00 FEE-REOUES PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �/L�Ut) rr• l_Z DATE <br /> v <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 'f• c; LOQ <br /> 2 aVem vJ S T. a I C) Unit 1 <br /> .e. srro. 5 (J s`7[. <br /> s. sma 02 WAl.tv,�'r S•T.�/ c; It � <br /> S. e CK S1.0�� s� m G R 5`, c. ` <br /> e. $veer 07 S p 5 f c a Unit 4 <br /> 9. 34e t l�l.rJv I eli II I.v f� <br /> Cry units �L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> L711N13ERCROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE F ,ate <br /> �¢THER CLEANUP SITE(NON-LOP) O FOOD FgCILfTY O SOLID WASTE V 3r "n <br /> OERGROUND TANK(MONRORINO/REMOVAL) ❑ DOG KENNEL ❑ 33 <br /> !JAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCHDAIRY •° ,,, p_f,- <br /> TIERED PERMITTED FACILITY O MOTEL/HOTELO PKG TREATMENT PLANT f <br /> ❑ TATTOO/BOOY PIERCING d PGOL/SPA PUMPER TRUCLICATION SITES <br /> MEDICAL <br /> ❑ MEDICAL WASTE FACILITY LAND USE APPLICATION SITES <br /> ❑ OTHER(PLEASE SPECIF'n <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 (2091 464.0138 or mail to the <br /> address Indicated above <br /> 2. EHD will notify the applicant If any END 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 END 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 END 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 END 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 /> EHD4&03a06 <br /> &=09 I �y-fJ�. /IJ„oc(C�r�Pss FDr (.11 a-�Uc.Cr?s?�t-f IU/I't-Q— .-i.IOSPS f-cF ,rf'5St s 17 5 U,IJ75f <br />