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j2PA10/2004 09:17 FAX 209 9481Q002/002 <br /> DATE RECEIVED EHO LOG NUMBER <br /> (�(� SAN JOAQUIN COUNTYPUQL.IC HEALTH SERVICES <br /> W L�CER FV�C�,D ' ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR ' <br /> STOCKTON CA 95202 <br /> FEB I 0 2004 (209)468-3420 <br /> +m_ENVjB0NMEkLaEALTw PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/ RY)PES M <br /> APPLICANT + + °`�`�`�� BUSINESSIAGENCY .�� <br /> ADDRESSg �yr"�l+< <br /> -S <br /> PHONE <br /> S*or-k-I-�+n cA- <br /> PHONE gel — 3 !S FACSIMILE 4ew—0 6 <br /> TENTATIVE'APPOINTMENT DATE 9117-10 &-i TIME <br /> (Please give 7 to 10 business days Vrom date of application submittal) <br /> CHECK DOX YO EXPEDi1'E REQUEST-587.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS �t <br /> SIGNATURE OF APPLICANT _ �� <br /> DATE ��/0 /oc/ a 4`,v) <br /> I - / <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> { 5-.U E G a�4.rQP RZ. Lo�fl.rop GA-- <br /> 00 �.c1 Lo �4 rep G�4 ! t! <br /> I <br /> a(n-)T\n1l1111 IL, IL-3111 low <br /> ENVIRONMENTAL HEALTH DIVISION FILES m. ' ' 3 <br /> It UNDERGROUND'rANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID F TY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY V SOLID WASTE VEHICLE <br /> rX UNDERGROUND YANK(MONITORINGIREMOvAL) C] DOG KENNEL DAIRY <br /> ;r HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENTPLANT <br /> X TIERED PERMri-mo FACILtrY ❑ MOTELIHOTEL • ® PUMPER TiMUCKlYARD1GHEM TOILETS+ <br /> O TATroo/soo'ePEIRCING ®•POOLiSpA "' XLANDUSE APPLICATION SITES <br /> Rf MEDICAL WASTE FACILITY Pr PUBLIC WATER SYSTEM ® OTHER(PLEASE SPECIFY ABOVE) <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(2091464-0136 or mail to the <br /> address indicated above., <br /> 2. EHD;will notify-the applicant if any EHO files exist An appointment for review will be confirmed. <br /> apprpximately 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 nee <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 thb same applicant may require a$87.00 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 busine , <br /> a <br /> _j t . <br /> CONFIRMED APPOINTMENT DATE TIME <br /> BATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />