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03/25/2004 17:49 4159899334 ENVSF � � e�f , L,��1� PAGE 02 <br /> t EHt]LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> . 304 E Weber Ave V door Stockton, CA 95205 <br /> ENVIRl'MMEid i HEA4h9)468-3420 Fax: {209}4640138 Web: www.co.san-j0aquin.ca.US/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUS[NE SIAGENCY: <br /> U ' <br /> ADDRESS: <br /> PHONE: �M / FACSIMILE: LU IG/ 112% <br /> TENTATIVE*APPOiNTMCNT DATC: S- Time; <br /> (Plaare allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.40 FEE-REQU PRGI SSED IN BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �Z r G� 'y DATE - <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> s, steal 1{ El Pym do D k on ❑ Unit 1 <br /> OL <br /> a. sf 2 !' <br /> opte. f Unit 2 <br /> a. � TO '5, Unit 3 <br /> S. s c Q <br /> 7. Cc nit <br /> ace a <br /> I�\" <br /> � <br /> Unit 5 <br /> 1.3 5Z <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ur—UNDERGROUND TANK(UST)CLEANUPSITr:(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> VOTHER CLEANUP SITE IKON-LOP) M FOOD FACILITY G SOLID WASTE VEHICLE <br /> NDERGROUND TANK(MONITORINWREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> CI HAEARDOUS WASTE GENERATOR O CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY i7 IAOTFLIHOTEL C3 PUMPER TRUCKIYARDICHEM TOILETS <br /> 17 TAIrromacav PIERCING it POOLISPA I Awn IMF APPI KATION RITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER jFLEASE SPECIFY) <br /> 1. hist up to ten addresses In the space above. Select the type($)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 ar mail to the <br /> address indicated above. <br /> 2. FHn will nntify 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 /> eCCOrdirtgly. <br /> 3. A file that Is actively being Worked on by EHA staff may not be immediately available for review. A new <br /> application may be submitted when the file Is available. <br /> d. Any fife not returned in the same condition ns 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 /> B. Applications received after 3:00 pm will be processed the neat business day. <br /> CONFIRMED APPOINTMENT GATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> �o aaaaaos <br /> arerioo� <br />