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03/25/2004 17:49 415989 934 ENVSF r �/ . `o2DoLl PAGE 02 <br /> 1REcEIvEO= EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> FNVIRUNME1'�E HENi41b9)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINEASIAGENCY: 4 <br /> ADDRESS: f_ 11 � ��o _ 6V3 ('d <br /> PHONE: " � FACSIMILE: <br /> TENTATIVE*APPOINTMCNT DATC: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.000 FEE—REQUF,�T PROI SSEDDIINN BUSINESS DAYS <br /> 31ONATURE OF APPLICANT 'Zz ' ��G " DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1, street l . H ElD O D L( city <br /> �] L. ❑ Unit 1 <br /> E Gi'{ G <br /> !' G ❑ Unit 2 --I <br /> L-1- 1 <br /> Cn �U n it 3 d �J <br /> s s Q c a S <br /> 4 -I o _'5f &Q r4 c,, �-� a g <br /> nit 4 <br /> a sae c a& <br /> s sr D G Unit 5 <br /> 7 <br /> o. s Zt .SGC <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KE'NNE'L a DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELlHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOJOODY PIGRCINO r, POOL/SPA ❑ 1 Alun IICF APP1 IC:ATtON RITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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(2091464-0138 or mail to the <br /> address indicated above. T <br /> 2. F.Hn 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. Tha files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A fila that Is actively being worked on by EHA staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> 4. Any the 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$93.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be confirmed with£HD staff. <br /> ti. Applications received after 3:00 pm will be processed the next business Jay. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> F'Ho 4a.024% <br /> M003 <br />