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06/22/2004 11:59 3037639 TECHLAW INC • PAGE 02/0 <br /> EHD LOG NUMBER <br /> DnT� iL SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 2 2004 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> ww <br /> (209)468-3420 Fax: (209)464-0138 Web:W .co•san joaquin.ca.uslehd <br /> ENVIROWIIIENT HLACM <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSlAGENCYt <br /> ADDRESS:,_ <br /> PHONE:, FACSIMILE <br /> Time:��— <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 bos(ness days from date of apPiicetlon 9ubmitt8l) <br /> CHECK BOX TO EXPEDITE REQUEST. <br /> $93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYSDATE <br /> IJ1 )'Y i r.Si Ili <br /> SIGNATURE OF APPLICANT 4z- Department Use Only <br /> S UNIT <br /> FlLE ADDRESS ,� Unit 1 <br /> L� , <br /> 2 � ��5 3: <br /> Unit 2 <br /> I o- <br /> 9SD SI c <br /> a. 0 0 Unit <br /> s sear b S• L h O <br /> s So-eal D S, C ✓ _ .Unii4 <br /> ,. su9M 3 S. L; <br /> e. Seem �` ✓✓ (� <br /> ca <br /> 10. avast <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �� <br /> HOUSINGAB �1 SOLID WASTE FACIL <br /> UNDERGROUND TANK(VST)CLEANUP SITE(LOP) 0 FOOD FACILITYEMfiNT Q SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORINGmEMOVAL) OO Cry CKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR 11 M KEEN AN 17 PUMPERTRIICKIYAROICHEMTOILET9 <br /> * TIERED PERMITTED FACILITY O POTELIHO ❑ LAND USE APPLICATION SITES <br /> OLISPA <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFYI <br /> O MEDICAL WASTE FACILITY <br /> 1, List up to ten addresses in the space above. Select the type{s)of files from the I4- above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (2091 x640138 or Lmall the <br /> address i0dicated aheve. ointment for review will be confirmed <br /> Z. EHD will notify the applicant if any EHD files exist. An app <br /> approximately five business days but no later than ten (10)days after receipt <br /> t Of aPPlshould be chedul The <br /> will be held for a maximum of five business days for review. Appointments <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 maybe submitted when the file is available. at the xpe <br /> 4. Any file not returned in the same condition as released will be reorgazed by E D staff prior to rev se <br /> of the applicant. Future rile reviews by the same applicant mayrequire <br /> w. <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHA staff. <br /> 6. Applications received after 3:00 pm will be Processed the next business day. <br /> E <br /> MED APPOINTMENT DATE TIME <br /> NFIRMEDPHONE FAX INITIALS <br /> ED YES NO REVIEW DATE <br /> EAn 40.0dU0@ <br /> AWMN <br />