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0312512004. 17:49 4159899934- - ENVSi Oo PAGE 02 <br /> --� <br /> L <br /> )[a�RE EItl [x I u%. EHD LOG NUMBER <br /> SAN J OAQUIN COUNTY <br /> MAR 2 5 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave V Floor Stockton,CA 95205 <br /> EWRGNMEil i-IEA4jb9)468-3420 Fax: (209)4640138 Web: www.co.san-joaquin.ca.US/ehC1 <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r 13USINE SIAGENCY: <br /> ADDRESS: <br /> � <br /> PHONE: r FACSIMILE: <br /> TENTATIVE*APPOINTMCNT DATC: <br /> {Please allow 10 businsss days from data of apptication submitblk <br /> 0 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQU T PROC 55ED IN BUSINESS DAYS 1 <br /> SIGNATURE OF APPLICANT r � 1 DATE <br /> Department Use Only <br /> FILE ADDRESSvrirr <br /> ❑ Unit 1 <br /> A L <br /> �. si Z r ❑ Unit 24. <br /> lit tilWF4 0h, q1q.29 1-7— <br /> s. <br /> Ts. By c p s. Unit 3 <br /> 6. 5f 4 AV- CI a <br /> r. -! Cl - O c� �& hltA <br /> B, 8 <br /> tr <br /> c, �& <br /> 9. 8 991 Cs Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> OrUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ! OTHER CLEANUP SITE{NON-LOP) ❑ FOOD FACILITY 0 SOUP wASTE VEHICLE <br /> I�UNRERGRQUND TANK(MONITORINWREMOVAL) CI DOG KENNCt. ❑ DAIRY <br /> G TREATMENT PLANT P <br /> ❑ HAZARDOUS WASTE GENERATOR C3 CHICKEN RANCH � C7 K <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELrKOTEL ❑ PUMPER TRUCKIYARP(CNEM TOILETS <br /> ❑ TATTooisoaY PIGRowc rl POOLISPA 0 r AHn IIRF APPF.RATION SITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to12091 464-0138 Or mail to the <br /> address indicated above. <br /> 2. FHn will nntify tha 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 /> t accordingly. <br /> E 3. A file that Is actively being worked on by EHI7 staff may not be immediately available for review. A new <br /> application may be submitted when tate file Is available. <br /> 4. Any file not returned in the same condition tis released will be reorganized by EHD staff at the expensc <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 /> 6. Applications receives after 3:00 pm will be processed the next business play. <br /> i - <br /> CONFIRMED APPOINTMENT DATE _u TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW MATE <br /> FjiD ae.azaR <br /> e,erzooa <br />'t <br />