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03/25/2004 17:49 4159899934 ENVSF ,4 wc)LF PAGE 02MD <br /> , <br /> E�f 61E0QD=:: 4 EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6' 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave V Ploor Stockton, CA.95205 <br /> ENVIRUNMEid l HEA-4-h9)468-3420 Fax: (209)464-0138 Web:www.cc.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: l BUSINE AGENCY: <br /> ADDRESS; `l r r`�r o11 _ �� co <br /> PHONE: FACSIMILE: �.� G/ <br /> TENTATIVE*APPOINTI41ChiT DATE: <br /> 1'r V <br /> (Please allow 10 businass days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REFEf T PR SSED IN BUSINESS DAYS III <br /> J////// <br /> SIGNATURE OF APPLICANT � �Z�• �. � DATE <br /> Devaatment Use Only <br /> FILE ADDRESS ;a VNri <br /> s,.., ❑ Unit 1 <br /> o ' L- <br /> '. s{ Zr10 ti, G T ❑ Unit 2 <br /> 4. c <br /> a, c - .491001-Init3 <br /> e. s Q C '' a <br /> nit 4 <br /> B. atre :57taeg cityJQ <br /> e. a est 0 /� a Unit.5 <br /> T9. b 'cf Z 61 ,7 <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> i <br /> 21"UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT D SOLID WASTE FACILITY <br /> OTHER CLEANUP SFiE(NON-LOP) ❑ FOOD FACILITY a SOMA WASTE VEHICLE <br /> O-UNDERGROUND TANK(MONITORINGIREMOVAL) M DOG KENNEL O DAIRY <br /> * HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKGTREATMENT PLANT <br /> ❑ TIERED PERINrrTED FACILITY 0 MOTELrHWEL O PUMPER TRUCKIYARDrCHEM TOILETS <br /> TATTOOIGODY P1CcRema f1 PooLISPA.; ❑ 1 ANN IICF avail ICLTIAN RITES <br /> 0 MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) <br /> 4. 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".MUST be selected. Fax to(209)464-0438 or mail to the <br /> address indicated above. <br /> 2. PHin will nestify 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 1~Hp 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 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 /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE 'TIME <br /> l <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FJIb4BA]A06 - <br /> BlBI2003 <br /> f. i <br />