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08/26/2003 11:35 2994671 AGE STOCKTON PAGE 01/0 <br />G-� <br />VE <br />S <br />Q �� Joa, uzN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />AUG 2 6 2003 304 E Weber Ave 3Td Floor Stockton, CA 95205 <br />E <br />Ef�1VIRUf�MENT N A i1 LT} 468-3420 F'ax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/e.hd 1460 <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: BUSINESS/AGENCY:I1G'�GC <br />ADDRESS: 513'Z/ `S-h� /U) /- a S�ockto Cp' <br />PHONE: �t/ �• '7 & l • ! LJ0►L! FACSIMILE: 0/163 <br />TENTATIVE* <br />, <br />TENTATIVE" APPOINTMENT PATE: , 0/I{ 6 3 Time: <br />(Please allow 10 business days from date of application submittal) �7 <br />- $93.00 FEE - RE U ST PR CESSED IN 3 BUSINESS DAYS <br />I CHECK BOX TO EXPEDITE REQ ' �d <br />SIGNATURE OF APPLICANT DATE <br />Department Use Only <br />1;jG L LUtQ <br />tNVIRONMENTAL HEALTH DEPARTMENT FILES <br />T' . UNIT <br />Unit 1 <br />f <br />[] Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT C SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) C7 FOOD FACILITY 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL D DAIRY <br />HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH C1 PKG TREATMENT PLANT <br />TIERED PERMITTEO FACILITY 10 MOTFL/HOTEL 0 PUMPER TRUCKlYARD/CHEM TOILETS <br />O TATTOO/13ODY PIERCING ❑ POOIJSPA M LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY U OTHER (PLEASE SPECIFY) <br />1. List up to tan 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. Fa_x_to (209) 464-0138 or mall to the <br />address Indicated abovo, <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 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 />6. Applications received after 3:00 pm will be processed the next business day. — <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED YES NO <br />8/8!2003 <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />�.. <br />r' � Ir • I • . r ' <br />.tet <br />��r�"ilat.� <br />� <br />� r . �►I► [/ els . <br />r � <br />'ice <br />� � , <br />��nl►t�IDa����lrt=�lil <br />1;jG L LUtQ <br />tNVIRONMENTAL HEALTH DEPARTMENT FILES <br />T' . UNIT <br />Unit 1 <br />f <br />[] Unit 5 <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT C SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) C7 FOOD FACILITY 0 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORING/REMOVAL) ❑ DOG KENNEL D DAIRY <br />HAZARDOUS WASTE GENERATOR 11 CHICKEN RANCH C1 PKG TREATMENT PLANT <br />TIERED PERMITTEO FACILITY 10 MOTFL/HOTEL 0 PUMPER TRUCKlYARD/CHEM TOILETS <br />O TATTOO/13ODY PIERCING ❑ POOIJSPA M LAND USE APPLICATION SITES <br />O MEDICAL WASTE FACILITY U OTHER (PLEASE SPECIFY) <br />1. List up to tan 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. Fa_x_to (209) 464-0138 or mall to the <br />address Indicated abovo, <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 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 />6. Applications received after 3:00 pm will be processed the next business day. — <br />CONFIRMED APPOINTMENT DATE <br />DATE CONFIRMED <br />REVIEWED YES NO <br />8/8!2003 <br />TIME <br />PHONE FAX <br />REVIEW DATE <br />INITIALS <br />