Laserfiche WebLink
03/25/2004417:49 4159P'k9934 ENVSF 'PAGE 03 <br /> EEE 1�Jl L`=� `) EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENT3041✓ Weber Ave 3'd Floor Stockton,CA 95205 <br /> PERMIT/SERV"1468-3420 Fax: (209)464-0138 Web: www.co.saLn-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: v"� BUSINESSIAGE CY: A `� /#Z-14,0-7 k <br /> 4C4 <br /> ADDRESS: '�W� 2 G"( (2e)PHONE: 1 "( J/`"l T/-1 ^' (� J FACSIMILE: /�✓ A <br /> TENTATIVE'APPOINTMENT DATE: I{�lx%TJ�`� /n1'i t 1.`. Timr: ..129 <br /> 111-1 <br /> (Please allow 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �s�< ���L � DATE <br /> Department Use Only <br /> FILE ADDRESS UNIY <br /> ,. sv '511Q(/' a a& ! L) ❑ Unit 1 <br /> oilp <br /> s s �� � `�� G V m ❑ Unit 2 <br /> s, r ra y- —N <br /> s. Q� aty ht= Unit 3 <br /> s, ZZ W Q�fP O <br /> °~ CA161-4-Lt ° Unit 4 <br /> s. OF A A10 EiA ° a ❑ Unit 5 <br /> 10. et 3 y c t <br /> 1'0 l2-! �C 3Sa8/c-C <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MUNI I VkINGIREMOVAL) O DOG KENNEL ❑ DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERE O PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOA300Y PIERCING ❑ POOL/SPA 171 LAND USE APPI Ir ATICIN SrTF3 <br /> ❑ MEDICAL WASTE FACILITY 0 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 neorg>anixed 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 /> 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 /> Eno�s o�aoc <br /> arerzoo� <br />