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18 04 09:11a sic 4k LIC WORKS 468 2 W p.2 <br />ID L•NUMBER <br />• SAN JOAQUIN COUEHD OGNTY <br />ENVIRONMENTAL HFALTH DEPARTMENT <br />MAR 18 2004 304 E Weber Ave 3d Floor Stockton, CA 95205 <br />ENVIRONMEWf Rffi411-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />PERMIT/SERVICES PUBLIC R-ECORDS RELEASE APPLICATION <br />BUSINESSIAGENCY`:__'24g:tM%to J=Iwo <br />APPLICANT; <br />ADDRESS: <br />PHONE: 4753- Wail FACSIMILE: <br />TENTATIVE* APPOINTMENT DATE: Time: <br />(Please allow 10 business days from date of application submittal) <br />1:3 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT zaog_��� DATE <br />Department Use Only <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />0 HOUSING ABATEMENT <br />)( SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />0 FOOD FACILITY <br />E3 SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />0 DOG KENNEL <br />XDAIRY <br />HAZARDOUS WASTE GENERATOR <br />rl CHICKEN RANCH <br />13 PKG TREATMENT PLANT <br />TIERED PERMITTED FACILITY <br />13 MOTELIHOTEL <br />0 PUMPER TRUCKIYARDICHEM TOILETS <br />173 TATTOO/BODY PIERCING <br />171 POOLISPA <br />0 LAND USE APPLICA110N SITES <br />0 MEDICAL WASTE FACILITY <br />0 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 C' hocking <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 laterthan 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 th6 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 />CQNFfRMED APPOINT <br />TIME <br />MIENTDATE <br />DATE CONFI E pHONE FAX INITIALS: <br />ftEVIEW,ED YES` 'NO ,REVIEW DA�,:T <br />E <br />F;HD 4842-006 <br />NA$2003 <br />A <br />