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03/25/2004 1.7:49 415989cgg4 ENVSF <br /> 9(. -aotf PAGE 02 <br /> L � r,'=IV�6-'U EHQ LOG NUMBER <br /> SAN JOA.QUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton CA.95205 <br /> ENVIRUNIVIEi-J HEA-41bg)468.3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINE S/AGENCY: w e/ ak <br /> ADDRESS: <br /> PHONE: "I FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATc: Z.9 l ` Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE-REQU T PROC SSED 1N BUSINESS DAYS <br /> 310NATURE OF APPLICANT 'Z'L- ' �� A DAT � <br /> E' <br /> Department Use Only <br /> FILE ADDRESS ;Unit <br /> +, sheaf r '4El O cev d k city ❑ <br /> E 2R G L <br /> a: st Z ( G ❑ <br /> �. �,i <br /> 5' d <br /> 6. S Q Cf C <br /> -/ o _ n o `�'� �g <br /> e. 8, � c 06 <br /> B. e D G <br /> to. s 'lit ;JOw A chy � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4?'-UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINWREMOVAL) ❑ DOG KENNEL 10 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOJGODY PIGRCINC 11 POOUSPA ❑ I Am IIRF APPI MATIAN RITES <br /> ❑ MEDICAL WASTE FAGII.ITY ❑ 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(2091 464.0138 or mail to the <br /> address indicated above. <br /> 2. F..Hn will nntify the applirant 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 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 /> 6. "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 BATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FHO4B-024M <br /> erertooa <br />