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63/25/2004 17:49 4159899934 EN115F PAGE 62 <br /> CEt <br /> I'D: <br /> EHO LOG NUM$ER <br /> SAN JOA,QUIN COUNTY <br /> LIAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 34 Floor.Stockton,CA 95205 I <br /> ENViR PvIU1EPd i HEA 468.3420 Fax. (209)464-0138 Web: www.co.san-joaquin.ca.US/ehd a <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINE 3IAjGEENsC�Y: <br /> ADDRESS; <br /> PHONE: FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: ` iTlMe. <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TG EXPEDITE REQUEST.$93.00 FEE-REQU T PROC SSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ATE <br /> I <br /> Depadment Use Only <br /> FILE ADDRESS uNnr <br /> gam, r u r~r o � D <br /> a L ❑ unit 1 <br /> a T ❑ Unit 2 <br /> e. oft, 1r� <br /> �Uni#3 <br /> \, <br /> _J c _ o G 29- <br /> nit 4 <br /> B, Beet Q Unit rJ <br /> ENVIRONMENTAL_HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST}CLEANUP SITJ=(LOP) ❑ HOUSING ABATEMENT D SOLID WASTE FACILITY <br /> � OTHER CLEANUP SITE(NON-LOP) b FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINWREMOVAL) Q DOG KENNEL 0 DAIRY <br /> * HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMIENT,PLANT <br /> ❑ TIERED PERMITTED FACILITY 13 U0tFUHOTEL M PUMPER TRUCKIYARPICHEM TOILETS <br /> M TATToomooy Pir.RCINC 1`1 P+]OLISPA ❑ T ARID tMr-avPI eGdTIAN RITES <br /> O MEDICAL WASTE FAGII RY M OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses 1n the space above. Select the type(s)of files from the list above by checking <br /> the appropriate box(es), At feast one file type MUST be selected. Fax (2091 <br /> _ to 464-0138 or mail to the <br /> address indicated above. T <br /> 2. FHn will nntify the applirant 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 rovlew. Appointments should be scheduled <br /> accordingly. <br /> 3. A fila 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 released will be reorganized by EHD staff at the expcnse <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 3:44 pm will be processed t>ho next business day. <br /> CONFIRMED APPOINTMI~NT DATE TIME: - <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> , <br /> REVIEWED YES NO REVIEW DATE; <br /> F14D 4B-02-M <br /> 878f200� <br /> ( <br />