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03/25/2004 17:49 4159899934 ENVSFr, PAGE 02 <br /> F° <br /> CEIV�D=�'�=% EHO LOG NUMBER <br /> SAN JOA,QUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave V Floor Stockton,C.A.95205 <br /> ENViRUNMEi� NEA41bg)468-3420 Fax: (209)4640138 Web: www.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINE SIAGENCY: <br /> f- <br /> ADDRESS; ��l i•� <br /> PHONE: f2 FACSIMILE: J1//.E2 "::/ �� <br /> TENTATIVE*APPOINTMCNT DATC: A2L//?"AP(�TIMQ; /! 6 <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE--REQU T PROC SSEDD INN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS/- UNIT <br /> L3. <br /> IA4Ef1Q dOk D city IRM01i Unit 1 <br /> 2l' G ElUnit 2 2y c �Un3 <br /> s s !( cl a <br /> O _ O city SFr nit4 <br /> B. 8tr city a <br /> e rt © Cw Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Gr—UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILFTY <br /> -OTHER CLEANUP SfTE(NON-LOP) 13FOOD FACILITY D SOLID WASTE VEHICLE <br /> Ia UNDERGROUND TANK(MIONITORINWREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY ❑ MOTFUMOTEL O PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOIDODY Pir.RCING 11 PO0U8PA ❑ 1 ANn[IRF APPI ICATIf114RITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(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(209146"138 or mail to the <br /> address indicated above. <br /> 2. FHn wlll nntify the applicant if any EHD 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 FHD 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 a3 relea3ed will be reorganized by EHD staff at the expense <br /> Of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> 6. *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 /> REVIEWE0 YES NO REVIEW DATE <br /> EH0491-C <br /> 0!Al2007 <br />