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03/25/2004 17:49 415 999934 ENVSF PAGE 03 <br />rl € `L EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br />ENVIRONMENT 304 F Weber Ave 3'd Floor Stockton, CA 95205"7 q <br />PERMIT/SERV S�468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.us/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: u °'i BUSINESSfAGE CY: _ �f /f� `� Vke ®7 <br />n <br />ADDRESS: <br />PHONE:{ ' / o/'c FACSIMILE: L-1�/✓� y L �/�✓� <br />TENTATIVE" APPOINTMENT DATE; <br />(Please allow 10 business days from date of application submittal) <br />CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE T REQUEST PROCESSED IN 3 BUSINESS DAYS <br />� SIGNATURE OP APPLICANTgEg&-,jm DATE <br />Department Use Only <br />UNrr <br />❑ SOLID WASTE FACILITY <br />❑ Unit 1 <br />Vt" <br />/� <br />❑ Unit 2 <br />y-�_Dy <br />a DOG KENNEL <br />Unit 3 <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />Unit 4 <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCK(YARD(CHEM TOILETS <br />❑ TATTOO/DODY r'IERCINC <br />❑ POOL/SPA <br />[I Unit 5 <br />❑ MEDICAL WASTE FACILITY <br />D OTHER (PLEASE SPECIFY) <br />11�•c3�:uLrl/I!S'J��!�/���✓C�.l, <br />Jr SM, Mil <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />/ <br />f <br />UNrr <br />❑ SOLID WASTE FACILITY <br />❑ Unit 1 <br />Vt" <br />/� <br />❑ Unit 2 <br />y-�_Dy <br />a DOG KENNEL <br />Unit 3 <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />Unit 4 <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCK(YARD(CHEM TOILETS <br />❑ TATTOO/DODY r'IERCINC <br />❑ POOL/SPA <br />[I Unit 5 <br />❑ MEDICAL WASTE FACILITY <br />AJ UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />❑ OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOUD WASTE VEHICLE <br />UNDERGRUUND TANK (MUNI I ORINGIREMOVAL) <br />a DOG KENNEL <br />❑ DAIRY <br />❑ HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />0 PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELMOTEL <br />❑ PUMPER TRUCK(YARD(CHEM TOILETS <br />❑ TATTOO/DODY r'IERCINC <br />❑ POOL/SPA <br />177 LAND USE APP[ jr,Arinm stTF_3 <br />❑ MEDICAL WASTE FACILITY <br />D 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 209 464-0138 or mail to the <br />address Indicated above. <br />2, EHD 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. 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 reorgalnixed by EHD staff at the exponsc <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 4"ZJXPG <br />V=0W <br />