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@3/25/2004 17:49 4159899934 ENVSFPAGE 02 <br /> 1 ' `,r - -_ <br /> C6It1 aff, U EHp LOG NUMBER <br /> SAN JOA,QUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`�Floor Stockton, C.A.95245 <br /> EP�VIRI)i'uMEid I �,qh9)468-3420 Fax: (209)464-0138 Web. www.co.san-joaquin.cams/ehd <br /> PERMITISERI�ICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��,( BUSINESS/AGENCY�ej : <br /> ADDRESS; V AM <br /> �`l r � � <br /> PHONE: Likiv FACSIMILE: <br /> TENTATIVE;*APPOINTMCNT DATC: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQU T PROD SSED IN BLISINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only <br /> FILE ADDRESS uNrr <br /> 1, sem, ! H1 porA dD 150 k. city ❑ Unit 1 <br /> r L <br /> a. s{ 2 ! c ❑ Unit 2 <br /> -5 <br /> s, 2 on b 1- Unit 36. 644*714q cay 000 <br /> C(� � <br /> ON <br /> nit 4 <br /> e. an J�- citya� <br /> a. a rr D <br /> ot, Unit 5 <br /> so, s Yit Ct ej <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O'UNOERGROUND TANK(UST)CLEANUP SITE(LOP) ❑,HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> Q OTHER CLEANUP SITE JNON-LOP) M FOOD FACILITY L3 SOU13 wASTE VEHICLE <br /> -UNDERGROUND TANK(MONITORINWREMOVAL) ❑ DOG KENNEL CI DAIRY <br /> 15 HAZARDOUS WASTE GENERATOR a CHICKEN RANCH fl PKG TREATMENT PLANT <br /> TIERED PERMrrTED FACILITY a=MOTEUHOTEL Cl PUMPER TRUCKIYARPICHEM TOILETS <br /> .0 TATToo/2oDY PIriRCINC ri POOLISPA ❑ r AN IIRF AM MATION RITES <br /> O MEDICAL WASTE FACILITY C2 OTHER(PLEASE SPECIFY) <br /> 1. List uo to ten addresses In the space above. Select the type(s)of flies from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 120914644138 or mail to the <br /> address indicated above. <br /> 2. FHFI will 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. Tho 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 FHA 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 expcnsc <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 I;HD staff. <br /> 6. Applications received atter 3.00 pm will be processet3 the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME _ <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> BIBIt007 <br />