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(THU)SEP 16 2004 13:43/SI. t4[/NO, 00 coag <br /> EHD LOG NUMBEI <br /> d'ATEiF2�C�IVED J SAN JOAQUIN COUNT' <br /> S E P 16 2004 H+NVIRONME HEALTH DEPARTMENT <br /> B Ave 3 ©� <br /> 304 Weber Ave 3`d Floor Stockton,CA 95205 <br /> ENVIR M;T E i Hc!„, �4G8-3420 Fax: (209)464-0138 Web:www.cosan-joaquin.ca us/ehd <br /> PERPliTlSERVIC . <br /> ,( // /PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT: swe LC/eR CJ'ttn BUSINESSIAGENCY: COnuPlurn Calsu� tr - <br /> ADDRESS: /0p3q/ n� /I/G <br /> PHONE: 4/07 - 796- 04 FACSIMILE: �- , — <br /> TENTATIVE*APPOINTMENT DATE: 9125 <br /> (Please■flow 10 business days from date of application submttls1) <br /> ❑ CHECK BOX TO EXPEDITEREQUEST-$91.00 FEE-REQUEST PRO ESSED IN 1 BUSINESS DAYS �J <br /> SIGNATURE OF APPLICANT i DATE 1 1 <br /> /1 y <br /> Denartfnent Use Only <br /> UNIT <br /> FILE ADDRESS <br /> r Fd htC3 Unit 1 <br /> 2. sued Z TA&7 I , <br /> ,, „ ❑ Unit 2 a <br /> s_ so-ea Unit 3 <br /> a. seed <br /> e. seed cC^ ^I <br /> e s� oN Unit 5 <br /> io. sveei <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> jFIIUNDERGROUND TANK(USTbLE <br /> )CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOUD WASTE FACILITY <br /> Z OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORING(REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKGTREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTFL ❑ PUMPER TRUC)GYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING 13LISPA E3 LARD USE APPLICATION SITES <br /> In MEDICAL WASTE FACILITY XOTHER(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 toFax to{209)484-0138 or mall to the <br /> or mall 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 schoduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A nev. <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 revieV <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 /> Enu awxaua <br /> e�erz000 <br />