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7 D04 PM Wei 0•46Anderson & Assoc. No .4226 "''P 2 <br /> SAN JOAQUIN COUNTY0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 17 2004304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> ENVIRONMENT Q?g1q All-3420 Fax: (209) 464-0138 Web: www.cO.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES n PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: p r 7wt I�GCfy p 1.�, BUSINESSIAGLEINCY:� / -- <br /> ADDRESS: IOZ- -2 US 0..l Y" -ISI-4 <br /> PHONE: 5(Ql .. J�O1 FACSIMILE: <br /> ��9 1Z�-g nn <br /> TENTATIVE'APPOINTMENT DATE: -317104 Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST- 93.00 FE REQUEST PROCESSED IN 3 BUSINESS DAYS ,1 <br /> SIGNATURE OF APPLICANT N" "/1y `—� <br /> DATE 2I1��0'l <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> Svee, 33 W. �ruL Sk• a `� ❑ Unit <br /> 2. Sveet 230 11\41,0e•4 %- <br /> �. Street 223 W• N)aS 94 City Lz, 3 ❑ Unit <br /> 93 I+� a. Rr a7o Unita l_ <br /> 5. Sveet rrJJ <br /> 6. Sveel <br /> 10 <br /> r si ee 0 K) yh�, U ❑ i Unit 4 <br /> a. sweet 33 E• M - Sk . Gt VW d a <br /> 9. Street 3 11 YMKO-✓r S•1 . ✓ I M nl <br /> 10. street 304 taa0. OrYC• CI (� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 14 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 14 OTHER CLEANUP SITE(NON-LOP) <br /> ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ❑ DOG KENNEL ❑ DAIRY <br /> I& UNDERGROUND TANK(MONITORING/REMOVAL) E3 11 <br /> RANCH ❑ PKG TREATMENT PLANT <br /> 0 HAZARDOUS WASTE GENERATOR 11MOTELfHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILET: <br /> TIERED PERMITTED FACILITY ❑ POOLISPA - ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICALTATTOOIWASODY PIERCING ❑ OTHER(PLEASE SPECIFY) - <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checkit <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to th <br /> address Indicated above. <br /> 2. EHD 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 file <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 r <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 expel <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to rev <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 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> �oeea2-0as <br /> erarza9s <br />