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10/2004 09:17 FAX 209 94808 1 Q002/002 <br /> DATE RECEIVED ENR LOG NUMBER <br /> nDSAN JOAQUIN COUNTYPUSLIC HEALTH SERVICES <br /> LS U ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> FEB 1 0 2004 STOCKTON CA 95202 <br /> (209)468-3420 <br /> EN PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/ Y)EES M o-rV./t <br /> APPLICANT_ Z-- K/-r-;^ <br /> BUSINESSIAG�ENCY <br /> ADDRESS ( S S /''l y r �f S*6r-k-tvri CA- <br /> PHONE ��g- �3�-1 S FACSIMILE 4e8-O 6 l <br /> TENTATIVE'APPOINTMENT DATE °fir l 7'l0 6Y TIME l C 00 <br /> (Please give 7 to 10 business days Trom date of appllcatlon subrnittal) <br /> CHECK DOX YO EXPEDITE REQUEST-$87.00 FEE-REQUEST PROCESSED IN 313USINESS DAYS <br /> /oc f �gf�GJ <br /> SIGNATURE ODATE o;-//o <br /> F APPLICANT <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> l 5 dt U FJ La+c,tr�P RZ. Lo�I.�oP cam- . <br /> 00 F- GA. <br /> i <br /> MA <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 1r UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENTsOUD WASTE FACILMf a�2h�1 <br /> P(OTHER CLEANUP SRE(NON-LOP) ❑ FOOD FACILITY VSOLID WASTE VEHICLE <br /> 0 UNDERGROUND YANK(MONITORNGIREMovAL) O DOG KENNEL )e DAIRY "�)� S <br /> 0 HAZARDOUS WASTE GENERATOR d CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> Pr TIERED PERMITTED FACILITY ❑ MOTELrHOTEL0 PUMPER-MU09YARDICHEM TOILETS $ <br /> O TATrootaoDY PEIRCING O•POOVSPA -'• LAND USE APPLICATION SITES y <br /> Ff MEDICAL WASTE FACILITY ja'PUBLIC WATER SYSTEM 0 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 /> theappropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 or mail the <br /> a r ss indicated above.• <br /> 2. EHD;will notify-the applicant If any EHO 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 nel <br /> application may be submitted when the file Is available. <br /> 4. Any file not returned In the Sarre condition as released will be.reorganized'by EHD staff at the expens, <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review <br /> 6. `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 /> [)ATE,CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />