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��01/07/2004 WED 14;30 FAX b02/002 <br /> Ul/U f/LUUY 1 L:U0 Y0�1�J0 L v11<UIYI"ICJY I I n r{yJt bl <br /> tnu LVu nV�wul.\ <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �D <br /> 304E Weber Ave 3'd Floor Stockton,CA 95205 I / <br /> JAN 0 7 2001 (209)468-3420 Fax: (209)464-0138 Web:www.co.san joaquin_ca us/ehd <br /> ENVIP,0NiVit-:;41 ilILALi i PUBLIC RECORDS RELEASE APPLICATION <br /> PERM111,MV D �/ <br /> APPLICANT: .YX il!/1 _ _ BUSINNE`SSIAGFNCY: �f//J/�C iTs30C/7`ITES <br /> ADDRESS: 112 /r,/ - <br /> PHONE:(tai) X a. I 1 FACSIMILE: <br /> TENTATIVE'APIPOINTMENT DATE:/Z/-7 Time: 1-160 10,41 -. <br /> W14L <br /> (Plea9e allow 10 6,15inass days rtefn date of apP0callon submitt0.n iU 7-ucsD�tY <br /> CHEXCK BOX TO FXPEDrrE REQUEST•S93.00 FEF.-REQUEST PROCESSED IN 7 DUSINESS DAYS 11/310'1 �'^ 4) <br /> 1 t <br /> SIGNATURE OF APPLICANT DATE ---�. <br /> DeparIrnent Use Only V <br /> FILE ADDRESS UNIT <br /> so- OS R S7oG D p Unit 1 <br /> s ODSNhil y loprn <br /> 3 SUeN AIA#I/ bR,+ Unit <br /> 03 NALry -DR/ <br /> s. soca Q SW A64 J /h ❑ Unit 3 <br /> ytV. <br /> 19 R. L <br /> e. swei / 8 a-95 G Unit 4 <br /> 7 s t / /Cl-/E [.E X115 <br /> s. swa11310 IIAZaLTON V6 <br /> nit 5 <br /> 9 SUeet <br /> t0. sad <br /> ENVIROWiIENTAL F9F1tt-TH DEPARTMENT FILES <br /> 15 itsOLID WASTE FACILITY._ <br /> :--itWu �ERGROUND TANK(UST)CLEANUP SITE(LAP) Q NOIIeMG A6ATEMENT ❑ SOUD WASTE.VEHICLE <br /> ¢POTHER CLEANUP SITE(NON-LAP) P FOOD FACILITY- 0 DAIRY <br /> tl UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL- ❑ PKG TREATMENT PLANT <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PUMPER TRUCKI'rARDICHEM TORTS <br /> ❑ TIERED PP.RMTTTED FACILITY 171 MOTEI.SOTEL <br /> ❑ TATTOOMODY PIERCING ❑ LAND USE APPLICATION SIT£5 <br /> ❑ POOUSPA <br /> 13 MEDICAL WASTE FACILITY ❑ OTHER(Pl-EASE SPECiF-n <br /> pes)of files tmm the list ahoye by checking <br /> 1. List up to ten addresses in the space above. Select the ty <br /> the appropriate box(es). At least one file typc MUST be selected. Fax to (209)46"139 o mail to the <br /> address indlaated aova. iLdconfi <br /> 2- EHD will notify the applicant if any EHD files exist An appointment <br /> for et of ill be 4onrmThe ides <br /> approximately five business days but no labor than ten(10)days receipt p <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordin9ly- <br /> 3. Afile that Is actively ubmittworked on by ed when the file D staff <br /> a able.not be Immediately available for review. ^e' <br /> application may <br /> 4. Any file not returned in the same condition as released will be reorganized 6y EHD staff at for tope <br /> ns <br /> file review,by the same applicant may require a$93.00 deposit prior to revie <br /> of the applicant Future <br /> 5, 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> g. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED App OINTMENT DATE TIMe <br /> �bATE CONFIRMED PHONE FAX -- `'R�IfCIAL3 <br /> r'- <br /> REVIEWED YES NO REVIEW DATE 4 <br /> Etio aaoz-eon . <br /> usrcoaz <br />