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93/25/2604 17:49 41598-49934 ENVSF -- PAGE, 03 <br /> UF� EHD LOG NUMBER ; <br /> SAN JOAQUIN COUNTY <br /> MAR 2 S 2004 ENVIRONMENT.A.L WALTH DEPARTMENT <br /> ENVIRONMENT 304 h Weber Ave 3'8 Floor Stockton, CA 95205 <br /> ��j468-3420 I�ax: (209)454-0138 Web: www.co.san-joaquin.ca.us/cfid <br /> PERMIT/SERVI E <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: u°'Lr BUSINESSIA, CY C Z-44 e1-7F <br /> ADDRESS: r /� r, <br /> PHONE: ( �(f f`t ^��l 3 FACSIMILE: �}� � �-7 '^ <br /> TE((TgT(VE'APPOINTMENT DATE;/ IY f r �l.' Tirnr: � <br /> (Please allow td buslnoss days from date of application submittal) <br /> Q CHECK 60XTO EXPEDITE REQUEST,-$93-00 FEE-RE4IUEST Pf4OCE&SED TN 3 BUSINESS DAYS <br /> SIGNATURE!OF APPLICANT Az �I � !r DATE <br /> Department Use Only <br /> FILE ADDRESS UNtr <br /> Xtj A cit, -2 4L ❑ Unit 1 <br /> a D <br /> s t <br /> a t/ © Unit 2 <br /> � Unit 3 <br /> 5)ZZ We-her AyenLC4 <br /> 45-F ;�7 <br /> t- 0E ��UnR4 <br /> O c <br /> ❑ Unit 5 <br /> to. et ?� 1' Y ^o <br /> Cju <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -CJf e - <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) A HOUSING ABATEMENT Cl SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY G SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MUNI I UHINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> 17 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH A PKG TREATMENT PLANT <br /> 0 TIEF(CO PEtMIMI)FACILITY l3 MOTELIHOTEI. ❑ PUMPER TRUCWYAROICHEIIII TOILETS <br /> 0 TATTOotBoDY nERCINC © P4CI.ISPA n LAND USE APPI 1r.A rinN SITF4 <br /> ❑ MEDICAL WASTE FACILITY a OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses'In the space above. Select the type(s)of files from the fist above by checking <br /> the appropriate box(es).','At least one file type MUST be selected. Fax to 203 464-0138 or mail to the <br /> address indicated above:' ' <br /> .2. EHO will notify the applicant if any END files exist. An appointment for review will be Confirmed <br /> approximately five busidess days but no later than teen(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 beiri;g worked on by EHL?staff may not be Immediately available for review. A new <br /> application may be sub;fitted when the file is available. <br /> 4. Any file not returned in dee same condition as released will be reorganixed 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:oo 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 <br /> EHD OA-a;-0oa -- <br /> tI/BfLPQ'f <br />