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03/25/2004 17:49 4159'- 934 ENVSF Pa's 03 ' <br /> LEHDIE1: �� LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTkL HEALTH DEPARTMENT <br /> ENVIRUNMF T � 304 E Weber Ave 3'8 Floor Stockton,CA 95205 <br /> II b8-3420 Fax: (209)464.0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PFRMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APP/L�ICATION <br /> APPLICANT• BUSINESSSIAGE CY .�. a <br /> 47x" 7 <br /> ADDRESS: <br /> PHONE:_ ( '( /"t ^�� /_ _—FACSIMILE: <br /> TENTATIVI='APPOINTMENT DATE; <br /> (Please allow 10 buslnoss days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIONATUR12 OF APPLICANT 7DATE 1 <br /> DepartMent Use Only <br /> FILL ADDRESS u,vrs <br /> city <br /> a C f' Unit ! <br /> Vily VrK <br /> �nw ❑` Unit 2 �/�{� <br /> a 0)vr.. f Unit 3 <br /> Lidluj-6) <br /> V 7.z � erW city 7 <br /> o <br /> o �Iur,it4 <br /> ONa93s Il <br /> Unit 5 <br /> ? ��o 124 C&, 35-28/co <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -d"UNDERGROUND,TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLaQ WASTE VEHICLE <br /> ,21'UNDERGROUND TANK(MUNI I OhiNGIRFMOVAL) O DOG KENNEL. 171 DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH fO PKG TRI-ATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYAROICKEM TOILETS <br /> ❑ TATTOOIGODY 17:111 NC In P.QQLNPA 171 LANG USE APPI.Iii dTlfiN SITRA <br /> ❑ MEDICAL WASTE FACILITY Q OTHER(PLEASE SPECIFY) <br /> I 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 209 484-0138 or mail to the <br /> address Indicated above. <br /> Z. EHO 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 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 reorganised by EHD staff at the expanse <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. "TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received atter 3:00 pm will'be processed the neat business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> q. <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 8182007 <br />