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TERRACON - RENO Fax:775-351-2423 Nov /1 "q03 13:47 P.01 <br /> OIRts¢EIV�Q' I \� �I' <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> N 0 V 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> ,CNVIRONMEN(?99AL, 0&-3420 Fax: (209)464-013$ Web: www.co.san_joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: -JO E BUSINESS/AGENCY: (✓ CO / <br /> ADDRESS: Z So V 0" Ir- C(YZ 1 <br /> PHON -Ti FACSIMILE: IIZS 35 2t(L 3 <br /> c.a�.Q �I'15'-�►SO'-. t �1 <br /> TMENT DATE: _"rd.. MCV IJ Tlme: 1;1 0tru <br /> (Please allow 10 businass days from date of application submittal) <br /> � � <br /> � <br /> CHE K BOX TO EXPEDI EQUEST-$93.00 FEE—REQUES PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _g2Lt) DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> i. sirw3 Q0 S. S $'T, c. L O �p Ole <br /> s street VO OR S'i. G'. �T o E7 Unit 1 <br /> i <br /> a. s S�t, c1ty IN L <br /> s aN s'T, s � 5 Unit 2 <br /> c; I <br /> s. st 02 E WIAL&IJT S7, <br /> S. <br /> �. S�root G R S c. <br /> e, O7 ,$ O 5-j_ t, Unit 4 �� <br /> 9. Stm F 0-'_NL / elf <br /> to. s�2et Ot C,t:TS^GR�L Pl.�l't c. nit 5 <br /> _� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ��1NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT Ef'SOLID WASTE FACT <br /> t'r THER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHI <br /> yNDERGROUND TANK(MONITORING/REMOVAL) O DOG KENNEL Cl DAIRY i" <br /> ARDOUS WASTE GENERATOR 11CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY Q MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> M TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> • 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(ea). At least one flie type MUST be selected. ,Fax to (209)464-0138 or mail to the <br /> addr s dlcat above. <br /> 2. END will notify 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 EHD 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 /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE II-I F TIME <br /> DATE CONFIRMED PHONE FAX INITIALS _ <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 46.OZda6 / <br /> ararsoos jl-y U3 /I J,;4G1CL1Y'S5 �✓ �) u �vC(����� Yu/� ' i�10 jFS 1 ti' G ,�r'sS r 5 � ] SG ICGrG'J 5f <br />