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03/25/2004 17:49 4159899934 <br />ENVSF <br />PAGE 01 <br />SAN JOAQUIN COUNTY <br />MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3 d Floor Stockton, CA 95205 q7 <br />ENV'iRIJIMiEV H,423g46&3420 Fax: (209) 464-0138 Web: www,co.sanjoaquin.ca.us/ebd 7 <br />PERMIT/SERVICES <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: <br />rula�-z� <br />FACSIMILE: <br />TENTATIVE` APPUIN I MEN I UA I E: ' (7 rime; �� •�"( <br />(Please allow 10 businass days from data of applkatlon submittal) <br />CHECK BOX TO EXPEDITE REQUEST • $93,00 FEE— REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT oe-s %i/ "��z'' DATE_ 2121; <br /><i/ eparlment Use Only <br />ROMER <br />UNIT <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />O <br />HOUSING ABATEMENT. - • <br />❑SOLID <br />WASTE FAc1UTY <br />D OTHER CLEANUP SITE (NON -LOP) <br />� <br />O <br />SONO WASTE VEHICLE <br />ll UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 <br />DOG KENNEL <br />M <br />DAIRY <br />0 HAZARDOUS WASTE GENERATOR <br />0 <br />CHICKEN RANCH <br />0 <br />PKG TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY <br />0 <br />MOTELIHOTEL <br />0 <br />PUMPER TRUCKIYARDICHEM TOILETS <br />C3 TATTOOeBODY PIERCING <br />17 <br />P00LIOPA <br />O <br />LAND VSE APPLICATION SITES <br />0 MEDICAL WASTE FAOIIITY <br />. <br />OTHER (PLEASE SPECIFY) <br />�i <br />:r <br />•�ii��-fes% <br />r . I <br />= <br />�► ry <br />� „❑ Unit <br />2 <br />Unit 3 �dAgO <br />o <br />Unit 5 <br />UNDERGROUND TANK (VST) CLEANUP SITE (COP) <br />1. Litt up to ten addresses in the spare above- Select the type(s) of fifes from the list <br />O <br />HOUSING ABATEMENT. - • <br />❑SOLID <br />WASTE FAc1UTY <br />D OTHER CLEANUP SITE (NON -LOP) <br />� <br />FOOD FACILITY <br />O <br />SONO WASTE VEHICLE <br />ll UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 <br />DOG KENNEL <br />M <br />DAIRY <br />0 HAZARDOUS WASTE GENERATOR <br />0 <br />CHICKEN RANCH <br />0 <br />PKG TREATMENT PLANT <br />0 TIERED PERMITTED FACILITY <br />0 <br />MOTELIHOTEL <br />0 <br />PUMPER TRUCKIYARDICHEM TOILETS <br />C3 TATTOOeBODY PIERCING <br />17 <br />P00LIOPA <br />O <br />LAND VSE APPLICATION SITES <br />0 MEDICAL WASTE FAOIIITY <br />In <br />OTHER (PLEASE SPECIFY) <br />above by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to 1209) 464-0138 or mail to the <br />address Indicated above. <br />2. END will notify tho opplioant If any END files oxist, An appointment for review will ho 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 fila that is actively being worked on by EHO 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 reorganized by END starrat 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 END staff. <br />6. Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED <br />erarsooa <br />YES <br />TIME <br />PHONE FAX INITIALS <br />REVIEW DATE <br />