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03/25/2004 17:49 4159899934 ENVSF PAGE- 01 <br /> v <br /> r ,, ru <br /> `, ` - <br /> Ew ti _ ' <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave P Floor Stockton, CA 95205 <br /> E[W ROViE(J H4OVY468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca,us/abd <br /> PERM TiSERVICES <br /> PUBLIC RECORDS RELEASE A�P/PLICATION <br /> APPLICANT: ' `1�•�Ot BU51NE7.S]W' AGE✓GEl/NCY: <br /> 2Ilvjj <br /> ADDRESS. <br /> PHONE: ('916) qqgY3 FACSIMILE: 1�4� qLlil7— <br /> ` f <br /> TENTATIVE*AYPUINI'MLNIUAIL: <br /> in fl w <br /> (Pieaae allow 10 bucinass days from date of application submittal) I 1 R <br /> ,14 <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSSSSEDDIN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � Gt/ ''/Gt f'/i'�'� DATE <br /> (% 0adment Use Only <br /> uar FILE ADDRESS UNIT <br /> s mt !O YIO Q a ❑ Unit 1 <br /> 3 "sd„1 O h 1 D ❑ Unit 2 <br /> 4. Htr et u✓lr. W e � C <br /> rr��qq r. 5- <br /> 5. lli4a IM c n <br /> 6. swot city �/ <br /> u3T Zf p cn !� Unto <br /> OCf9t <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> l'UNDERGRQUNO TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 13 SOLID WASTE FACILITY <br /> CI OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SQUID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> O TATTOo/BoOY PIFRCING E3 POOLICPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the e:pace 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. EHO will notify the applioant If any EHD files exist. An appointment for review will he.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 starrat 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 /> EHD d"21 <br /> emll6w <br />