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Q 03/ 25/ 2004 17 : 49 415980934 - ENVSF - PAGE 03 <br />( r� EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENT304 E Weber Ave 3'a Floor Stockton, CA 95205 jqq <br /> PERMIT/SERV S3468-3420 Fax: (209) 464=0138 Web: www.co.sanjoaquin.ca.us/chd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: • BUSINESS/AGE CY �' " Z/k Q®7 <br /> ADDRESS: *2� Oru5 00 <br /> PHONE: l `"l l�/"( v �� J J FACS��IMIIJL,EE�:,.////y',� <br /> TENTATIVE" APPOINTMENT DATE; (/.e%(J� f r i l.' , Time: � � <br /> (Please allow 10 buslnoss days from date of application submittal) <br /> El CHECK BOX TO EXPEDITE REQUEST • $93.00 FEE — REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ,s it _.v 9i ' AzIS �2 DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> r. sr 1 14A G cvn a & LL) ❑ Unit <br /> u n4o <br /> a s ' 1 Ftr `W G C V m ❑ Unit 2 <br /> 4. 31 1 G 6 m <br /> s. GI/ air 12121 Unit 3 <br /> e. <br /> aIrq zz We er - A Det1 _ <br /> e b ` e OP t1 s �Unif4y <br /> , . rte a Ci ,2955 eI /] <br /> s. O c a ElUnit 5 <br /> la el 3 y c a <br /> /2I / C10 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ajo�UNVERGROLND TANK (UST) CLEANUP SITE (LOP) A HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE (NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> ,O' UNDERGROUND TANK (MUNI 1 OHINGIRFMOVAL) O DOG KENNEL M DAIRY <br /> M HAZARDOUS WASTrGENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEL.lHOTEL 0 PUMPER TRUCK/YAROlCHEM TOILETS <br /> O TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPI ICATION 4rrFS <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER (PLEASE SPECIFY) <br /> 1 . 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(es), At least one file type MUST be selected. Fax to (20914640138 or mail to the <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 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 [lie 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 TIME . _ <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> D1P 4"4i <br /> arerzaw <br />