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- _ 51 t<A I US NJ CALIF PAGE 01/0 <br /> DATE ' trtu Gum�unnestK <br /> SAN�f®AQU'�T COUNTY' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 10 2004 304 E Weber Ave Yd Floor Stockton,CA.95205 Ar R <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin,ca.us/ehd 11 <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ 1<11 M Att.ARAJO BUSINESSIAGENCY:_ S►kAj-(IC EnlyriCuNMLn►Titl., rv�. <br /> ADDRESS: 3330 CA•metxN PgLy— bR.tye , SutTs 45s0 Ckme"rl PhtLo CPN °1-682, <br /> PHONE:0530) 6q-b coal- FACSIMILE:—f 30) 6-+b 6005 <br /> TENTATIVE*APPOINTMENT DATE:09112-104- - Time: Q a 0 0�rQ <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$ 3 0 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT -AA 1-' DATE U 81110]Lt <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> t. so-oot x�tJ�a C8t1nITtCM GW E <br /> cilys tI�'fgt`1 <br /> Z street elty Unit I <br /> 3. SrrwOily ++Zoq <br /> a. Stmel ❑ Unit 2 1 <br /> 5. suet to Unit 3 <br /> 6. Street <br /> T. street c Unit 4 <br /> a. Stmet C <br /> S. street city tl -2 20,11,• <br /> ao. stmot CRY- <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) CI HOUSING ABATEMENT ❑ SOLID WASTE FACILITY >` <br /> 'OTHER CLEANUP SITE(NON-LOP) ® FOOD FACILITY Ct SOLID WASTE VEHICLE <br /> 'UNDERGROUND TANK(MONITORINGIREMOVAL) E3DOG KENNEL O DAIRY <br /> V-*AA7ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ® PKG TREATMENT PLANT <br /> ❑ .TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLlSPA ® LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ 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 <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02.005 <br /> al9/2tl0, <br />