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09 / 13 / 2004 11 : 53 FAX 209 948 ( [x002 / 002 <br /> SEP 13 704 11 : 19AM COS—IgUD ENGINEERING P , 1/1 <br /> it <br /> DATE RECEIVED EHD LOG NUMBER <br /> SANJoAQrJnv COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3r4 Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web ; www.co.san-joaquin.ea,us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUS IN ESSIAGE NCYL . <br /> ADDRESS;A0?h5OO V Drove T Ste) kto16 (ra <br /> PHONE: ;R7E7 FACSIMILE: 9.— 937�--46777 <br /> TENTATIVE" APPOINTMENT DATE: Time: <br /> ,�----II (Plesee allow f4 bu3ines7 days them date or application tubmittal) <br /> CHECK 13OX TO EXPEDITE REQUEST - 393.00 F — I? T PROCESS 1 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE q <br /> Depanment Use Only <br /> FILE ADDRESS UNIT <br /> su� q <br /> wo ❑ Unit 1 <br /> ci ❑ Unit 2 <br /> �. aneel <br /> 5. smOL <br /> C <br /> G. s"er ❑ Unit 3 <br /> T. a <br /> r7 Unit 4 <br /> OL si noI ci. <br /> a.�Swnml Cn <br /> ❑ Unit 5 <br /> �o. aueel cis <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> p UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT M , SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP 817E (NON-LOP) ❑ FOOD PACILrTY ❑ I SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ , PKO TREATMENT PLANT <br /> ZJ TIERED PERMITTED FACILITY M MOTEL/HOTEL ED PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING CI POOIJSPA 4 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER (PLEASE $PECIFY) <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 flies 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 far a maximum of five business days for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is 0etively being worked on by EHD staff may not be Immediately available for review. A new <br /> application maybe 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 some 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 <br /> DATE CONFIRMED Postmita Fax Note 7671 Dare R I"3�04 pages ' 1 <br /> REVIEWEDTo YES NO 1D0U NeaC FfO1" A� , �}Ipfe oZloo <br /> ENu �e.oaaoe Co./DapL v< 16, � � co. C 5 <br /> 0 wow Phone 41 Phano0 937 - $ 787 <br /> 537 - 877 <br /> 09 /13 / 2004 MON 11 : 16 [ TX/RX NO 7273 ) Dal <br />