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:46PM Nei 10. Anderson & Assoc. No•4226 E`"P• 2 <br /> ` V[ I SAN JOAQU>N COVNTIN.../ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 17 2004 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> ENVIRONMENT I§HL�A68-3420 Fax: (209) 454-0138 Web: WWW.co.san-joaquin.ca.us/ebd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: q A AA (2,, .v BUSIN`ES`SIAG�EyNCY: 96 t 0 • A-r t"v s P-21 <br /> ADDRESS: <br /> PHONE: rt) 2_4 --3-+D- FACSIMILE: 3uq - L+-2--48 <br /> TENTATIVE-APPOINTMENT DATE: 3l-2-IO Time. <br /> (Please allow 10 business days from date of application submittal) <br /> C1 CHECK BOX TO EXPEDITE REQUEST-123.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> street 33W T-%AR_ S� Ct fin' `�"' ❑ Unit I <br /> L-0012. Street 2160 �l'�OIV�t1 �•1 F1 �1 rn�. <br /> 3. Street 2 Z7j W• W Ok% Are-•94 • Ci � oZ � � ❑ Unit 2 <br /> n , <br /> 4. Street e4h <br /> 5. sleet q3 Cit �7�.� tn <br /> 6. Street 1 0 KOt S� Cit F-t 8Y\ <br /> 7. street �j C�• 1�� d 0 ; I rwn t <br /> 0. Street 33 V- s'T Cit V Ie r �J a <br /> 9. street 3 11 �- VK�'� '1^^_J l/ t (� " �Y� <br /> to. Street 304 tct.ua KV{' Ci F-+ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I& UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑❑ HOUSING <br /> OD FAC1ABALITYTEMENT 0 SOLID WASTE❑ SOLID WASTE VEHICLE <br /> JQ OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> P& UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH d DAIRY <br /> TREATMENT PLANT <br /> 0 HAZARDOUS ER WASTE GENERATOR ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILET: <br /> ❑ TIERED PERMITTED FACILITY <br /> ❑ TATTOO/BODY PIERCING C] POOLISPA ❑ LAND USE APPLICATION SITES <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 checkit <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to tht <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 file <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 r <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 EHD staff at the exper <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit.prior to rev <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�q•02•o06 <br /> SM003 <br />