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03,/25/2864 17:49 415989 34 ENVSF r �/ D0 PAGE 02 <br /> ma T 61ECEIV�t�IIJ; <br />� - ii � EHt]LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA,95205 <br /> ENVIRUNMLi`J i i-IEAghg)468-3420 Fax: (209)464-0138 Wcb; WWW.co' .san-joa0in-ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> AFP1aCANT: �{B.UpSINE 3lAGENCY: V �Ly Com[ <br /> ADDRESS: I_ dtD [r� <br /> PHONE: FACSIMILE: rJ.y� G/ ere? <br /> TENTATIVE*APPOINTMENT DATC: <br /> (Please allow 10 businass days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$193.00 FEE-REQU T PRDC SSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT L)ATE ��- <br /> Department Use Only <br /> 4 FILE ADDRESS UNrT <br /> e, sorrel ( H E( n dv o k CIIY <br /> ❑ Unit 1 <br /> A4 0"I G L <br /> c 33 �- Unit 3 <br /> nit 4 <br /> e e eat D G Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G�_`UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ GTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOUP WASTE VEHICLE <br /> i9UNDERGROUND TANK(MONITORINWRF-MOVAL) ❑ DOG KENNEL 0 DAIRY <br /> IQ HAZARDOUS WASTE GENERATOR C7 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 LIOTELmOTEL ❑ PUMPER TRUCKIYARPrCHEM TOILETS <br /> P TATToomooY PI¢rtcwcn POOLISPA ❑ 1 ARIn I ISE APPI MATIAN RITES <br /> P MEDICAL WASTE FACILITY t7 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(209)464-0138 or mail to the <br /> address indicated above. T <br /> 2' FHn will r+ntify 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. Tha tiles <br /> will be held for a maximum of five business'days for revlew: Appointments should be scheduled <br /> aor�rdingly. <br /> 3: A file that Is actively being worked on by EHP 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 sante condition as released 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 /> 5 *TENTATIVE appointment dates must be confirmed with JEHD 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 REVIEW DATE <br /> >:r+o�fl.a�aoc <br /> &9f200i <br /> I <br /> !+ - ,rte- <br />