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08/26/2003 11: 35 2094R-",118 AGE STOCKTON PAGE 01/0 <br /> p� 73 "IC Fn\ tnu tvj rvuMnt <br /> �Ur -'J_�lrJ(`\ l�, `ll SA.�1.TO.A.QiTINCOUNTY <br /> ENVIRONWNTAL, WALTH DEPARTMENT <br /> AUG 2 6 2003 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> (2Q7�468-3420 Fax: (209) 464-0133 Web: www.co.san-joaqum.ca.us/ehd <br /> Ef�JVIRU(`1f��E`JT HttAL <br /> 0 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINES�SIAGENCY: G� Oreo �nvironm�/1�Zt <br /> ADDRESS: d'3 w a S�ocl'C& C('} / /, / <br /> PHONE: q• '7 Co / �OQ�/ FACSIMILE: �}0/l, CFI /// [� <br /> �J` <br /> TENTATIVE*APPOINTMENT DATE: al O(�7 (1 3 Tlmo: /L/ •V V <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQ -$93.00 FEE—RE91_1ST PR CESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT DATE A`Q <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> S D Yo l4--. IY70 ki e-t S 7Y3 3 2 Unit <br /> 2. SVaet r�1 <br /> "y 4-0101 <br /> Street G Q It.2 <br /> �] <br /> CiTA <br /> ty C� !` ' t�3 <br /> 5. Street U r , GI /1 `I <br /> B, Start city <br /> 7. Street City t <br /> 4 <br /> 8. Stmvt city <br /> 9, street Cls ❑ Unit 5 <br /> 10. Street CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) 13 DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTEL/HOTEL 0 PUMPER TRUCK/YARD/CHEM TOILETS <br /> O TATTOO/BODY PIERCING 0 POOLISPA C LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY Q 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 (209)464-0138 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 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 TIME job <br /> DATE CONFIRMED PHONE FAX.- INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4A.02-09t; <br /> 8162003 <br />