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Mar O1 04 QS• 4p ANG' - BALAJI 510 F- 15904 p. 2 <br /> v <br /> Fn)Er <br /> ^ 2 23 464013 ENVIRON4ENTAL HEAL, PAGE 01 <br /> W ��'��I \� SAN JOAQUIN COUNW <br /> MAR 0 2 2004 ENVIRONMENTAL IiEALTH DEPARTMENT <br /> 304 E Weber Ave 3"Floor Stockton,CA 95205 <br /> ENVIRONMENT HEAL")468-3420 Fax:(209)464-0138 Wtb:www.co.san joaquin,ca.USlehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPucmT: A L-L7BUSINESSfAGENCY: <br /> ADDRESS- s i-c c t_ L- 0i t`R C L l� W_6 j iZ i S+o ee} �, e r•9— �t S�-C L <br /> PHONt::_std � S`(-I '� �t C i ACS1htQF: 5 t 6 S o �( <br /> tc�101st <br /> TENTATNE'APPOINTMtENT DATE: I I mrv� ! Tkne: 14-- <br /> r. <br /> (Please allow 10 binlness daysof applkauon submaw C <br /> I 7D 2004 <br /> E3 CHECK BOX TO EXPEDrTE REQUEST >i9 FEE— QUEST PROCf53ED fN 2 BIfSfIVESS GAYS <br /> SIGNATURE OF APPLICANT DATE <br /> D8Mft Wg Use Onty <br /> FLE ADDRESS UNIT <br /> z. a ❑ Unit 1 <br /> n. City <br /> �. <br /> ,, 8ee et ❑ Unit 2 / <br /> >xM <br /> e etre , Unit 3 <br /> •, ne.Mit 4 <br /> w. eeeee <br /> "� ❑ Unit 5 <br /> City <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FEES <br /> DI DERGROUND TANK(UST)CLEAr1UP SITE ❑ HOU$ <br /> (LOP) Mi0 ABAT'ElrRENT ❑ SOLA WASTE FACILITY <br /> =CLEANUP SrTE(NON•1OP) 13 FOOD FACILITY ❑ SOLID WASTE YEHXXF <br /> GROUND TANK(MONITDWNGIREMOVAL) ❑ DOO KENNEL ❑ DAIRY 9 <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT POINT <br /> ❑ TIERED PERMITTED FACILMY ❑ MOTELJHOTEL Op PUMPER TRUCKlYIRD/CHEM TOILETS <br /> 13 ME01�WASTE FAA�ny 0 OTHER(PLEASE SPEC"L H Z!Y�F}T� 4T1ON i'r <br /> 1. last up to len addresses In the space above. Select the type(s)of files mmltha list aboye by checking <br /> the appropriate box(es). At least one file type MUST ba selected. Fax to(249)4G4-0138 or mail to the <br /> address Indicated above. <br /> 2. EHO 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 END staff at the expense <br /> of the applicant Future file reviews by the came applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appoinWent dates must be confirmed with EHD sta . <br /> 6. Applicationff . <br /> Applications received after 3:00 pm will be processed the next busheess day. <br /> CONN ftp APPQINI`ME10DATE, .r TIME S} <br /> DATECONFIRMt=D PHOfi7E <br /> FAX '� NItIALS <<<4 <br /> 1tt_VIMED YES NO <br /> REVIEW DATE - <br /> END"4:.0(16 <br /> wioe� <br />