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SAN JOAQUIN COUIN TY EHD LOG NUMBER <br /> JUN 2 4 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3dFloor Stockton,CA 95205 <br /> L�H68-3420 Fax:(209)464-0138 Web: Www.co.san-joaquin.ca.us/ehd <br /> ENVIRUiVrd1E(\�T 2� <br /> PERMIT/SERVICES PU13LIC RECORDS RELEASE APPLICATION <br /> APPLICANT' r El L9 <br /> Q OG7 <br /> PHONE r V�=PA-CNMILE:__ 9132-. <br /> TENTATIVE*APPOINTMENT DATE: 11)C9-�' 2g ka I Cg Tkm: <br /> (Please alloy 10 tiutrinrsa days from date of applirMlon soMft l) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FE't-REQUEST P ESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Dopar. nen!Use Only <br /> FILE ADDRESS UNrr <br /> t. ew.i9b > <br /> se.ai ❑ Unit 1 <br /> a. swn Ll Q � IU <br /> I. so,aUnit 2 �(k <br /> s. Sv..t <br /> CRY 4 <br /> Unit 3 <br /> T sit <br /> a^ nit 4 <br /> Cky to. $asst ❑ Unit 5 <br /> ��JJU�r <br /> ENVIRONMENTAL HEALTH DEPARTMENTFILiES rACI I4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 13HOUSING ABATEMENTSOLID WASTEY <br /> 19OTHER CLEANUP SITE(NON LOP) ❑ FOOD FACILITY C7 SOU0 WASTE VEHICLE <br /> X UNDERGROUND TANK"tTORINGAREmoVAL) ❑ DOG KENNEL ❑ DAIRY <br /> R HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMrTTED FACILITY 0 MOTEUU01-EL O PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ TATTOOA30DY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> a MEDICAL WASTE FACam 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the <br /> 101Ms indicated above <br /> 2. EHD will notify the applicant If any EHO 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 /> s. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTME=NT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE FP D., a Iq <br /> rroneoa � :. may, a` <br />