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03/17/04 15:54 FAX 2001 <br /> v <br /> EHD LOG NUMBER <br /> AT <br /> R , � SAN JOAQUIN COUNTY <br /> II \ ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 1 7 2004 304 E Weber Ave 3`I Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin-ca-uslohd 1131* <br /> ENVIRUN1v1EN i HEALTH <br /> PERMI?ISERVICES pYJSLIC RECORDS RELEASE APPLTCA'I'ION <br /> APPLICANT: Ot BUSINESSIAGENCY= <br /> o r u p <br /> ADDRESS: 2SY FACSIMI i U A <br /> PHONE: l p <br /> TENTATNE`APPOINTMENT DATE:��� —T�• 'tel <br /> (Pleas,allow 10 business days from date of application submittal) <br /> • CHECK BOxTO EXPEprtE REQUESy'J$93.00 FEE-RE U ST PROCESSED IN 3 aUSINESs DAYS Q <br /> SIGNATURE OF APPLICANT p,partrnent Use only <br /> UNIT <br /> FILEADDRESS <br /> 1. s� <br /> Unit 1 <br /> • s i l � l I , , G; n��� <br /> a a. ePCel ,t <br /> ,a. 9hcel <br /> 4 . <br /> a SWeI Unit 4 aglow <br /> G <br /> 7. <br /> sl aPt <br /> Gl <br /> e. ,ted, t�AR Units <br /> P. 5 em <br /> C <br /> 10. Somal <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES ¢ <br /> SOLID WASTE <br /> HOUSING ABATEMENT <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) FppD FACILITY soon WASTE <br /> OTHER CLEANUP SITE(NON-LOP) KENNELDOG CKs-DAIRY <br /> UNOERGROUNDTANK(MONITORINGIREMOVAL) CHCKENRANCH k PKG TREATMENT PLANT <br /> �-HAZARDOUS WASTE GENERATOR 0MOTFIIHOTEL A PUMPERTRUCK(YARDICHEMTOILEfS <br /> Er TIERED PERMITTED FACILITY p POOLISPA LAND USE APPLICATION SITES <br /> �TATTOOMODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> MEDICAL WASTE FACILITY checking <br /> 1. List up to ten addresses In the space above. Select the type(s)of les from the list above by <br /> the appropriate box(es). At least one file type MUST be Selected. Fan. <br /> ranm en.�n73R or ma to e <br /> dr ss i dic d above EHD files exist. AD appointment for review will be confirmed <br /> 2. EHD will notify the applicant if anyapplication. The files <br /> approximately five business days but no later than ten(10)days aoftnreceipt should be scheduled <br /> will be held for a maximum of five business da for review. App <br /> accordingty. <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 /> at 4. Any file not returned In the same condition as released will be r niz staff prior rev eco. <br /> of the applicant. Future file reviews by the same applicant <br /> Y require593.0 deposit P <br /> g• *TENTATIVE appointment dates must be confirmed with EHD staff. ) <br /> B• Applications received after 3:00 pm will be processed the next businessd ._. � F '�°:: <br /> TIME <br /> CONFIRMEDAPPOINTMENT DATE INlI1/\IS <br /> DATE CONFIRMED PHONE FAX• <br /> REVIEWED YES , <br /> NO". REVIEW DATE' <br /> EMP AUG <br /> e�e20a1 <br />