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03/25/2004 17:49 4159Pcg9934 . ENUSF PACE 83 <br /> f ;1 , � _ .� <br /> I�� EHD LOG NUMBER <br /> LJ SAN JOAQUIN COUNTY <br /> MAR 2 6 2004' ENVIRONMIENT&L JUALTH DEPARTMENT <br /> ENVIRONMENT3U4 E Weber Ave TdFloor Stockton,CA 95205 <br /> wjq q <br /> PERMIT/SERV 468-3420 Fax:{209)464-0138 Web: www.co.san joaquin.ca.us/ehd' <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l6r"( BUSINE SIAGf <br /> ADDRESS: (2, <br /> PHONE: ! '`(115 +i"L_*q J _ FACSIMIL,EE- (l/Fn7 <br /> TENTATIVE"APPOINTMENT DATE; ���v`�i r � <br /> (Please allow 10 businoss days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE dP APPLICANT 'lam DATE <br /> Department Use Only <br /> FILE ADDRESS uN1Y <br /> a& 4t. Unit 1 <br /> lT F `�� G V'um ❑ Unit <br /> St I <br /> s. Acw W0.0c, 1WICAG 3Sa rOvop unit 3 �d5) <br /> �. s ZZ Weber Atenffe EO,5-/- <br /> UnR4 <br /> o a9'S5 11 <br /> g. ffi CRY Unit S <br /> 10. at 3 C 'L <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ad1*UNDERnACHJND TANK(UST)CLEANUP SITE(LOP) A .HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> d OTHER CLEANUP SITE(NON-LOP) M FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MUNI l011ING;REMOVAL) C3 DOG KENNEL ❑ DAIRY <br /> C1 HAZARDOUS wASTE GENERATOR CI CHICKEN RANCH CI PKG TREATMENT PLANT <br /> 0 'TIERED PERMITTED FACILITY 13 MOTEOHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATToonaoov rwRcimc ❑ POOL/SPA. ❑ LAND USE APPr Irnrinu SITFS <br /> 0 MEDICAL WASTE FACILITY D QTHER(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 209 464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any F-14D 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 fiva 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 new <br /> application may be submitted when the file is available. <br /> 4. Any file not retumed ire the sante condition as released will be reorganized by EHD staff'at the exponsc <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 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 ftEVl111w DATE <br />