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-IM <br /> w - .s/ =0 39 CAMI3R I A 1707 935 6649 P-02/02 <br /> �t�{ emu 4.%0%71.W.w� <br /> DATl t(� SAN JOA* QUIN COUNTY `%.4 <br /> FsmoNmENTAL.HEALTH DiPARI EENT <br /> OCT -8 2003 304 E Weber Ave P Floor Stockton,CA 95205 <br /> t--NVIRONMENfP2 ?�ffl-3420 Fax: (209)464-0138 Web:www.co,san-Joaquw.c;Lus/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ADDRESS: Z-4o r Lin s S 4*A--4'���c�n�f o. CA <br /> PHONE: rYtSc FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 0C4g Ce r 13 Tlrne: l oea <br /> (Please allow 10 bwlnms dap from date of application submittan <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCE33ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE IO 8 a3 <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 5 [] Unit 1 <br /> X 5"91 air p Unit 2 <br /> 4. IM Cffv <br /> Unit 3 <br /> 7. OPM cj Unk 4 <br /> U 5 <br /> 10. sa.n -gu . J <br /> -7H <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 4OUNDERGROUND TANK(UST)CLEANUP SITE(LOP) C HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> t7 OTHER CLEANUP SITE(NON-LOP) D FOOD FACILITY 0 SOU13 WASTE VENICLE <br /> 0 UNDERGROUND TANK(MONITQRWGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> O HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH 13 PKG TRIIATMENT PLANT <br /> Q K/ <br /> IUMD PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCYARDICHEM TOILETS <br /> O TATTOOIBODY PIERCING O POOLISPA CI LAND USE APPLICATION SITES <br /> MEDICAL.WASTE FACILITY D OTHER(PLEASE SPECIFYt,�� - <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax W 091 4&t-0435 or it to the <br /> address Indicated above. <br /> 2. END will notify the applicant if any END files exist, An appointment for review will be confirmed <br /> approximately five business days but no later than ten(10)days after receipt of*Wliaation• 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 END staff may not be immediately available for review. A ne <br /> application stay be submitted when the file is mmilable. <br /> 4. Any Nle not returned in the same cond)tlon as released will be reorganized by.EHD staff at the expens <br /> of the applicant. Future file reviews by the same applicant may require a:93•00 deposit prior to revie <br /> 5. 'TENTATIVE appointment dates must be confirmed with END staff. <br /> 6., Applications received atter 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 Iff j <br />