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EHD LOG NUMBER <br /> DATED <br /> ECEIVED -Il .� SAN JOAQUIN COUNTY <br /> ENVIiZONMENTAL HEALTH DEPARTML,-' <br /> FEB 0 6 2004 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> �n _�'PUBLIC RECORDS RELEASE APPLICATION / n <br /> APPLICANT: i 71�1 °LI 7LA LL I BUSINESS/AGENCY: <br /> ADDRESS: (�r/o L13 -y <br /> PHONE: FACSIMILE: o�D Og <br /> ' q&zeq ^ n <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED <br /> PRROOCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /22 DATE d <br /> Department Use Only <br /> FILE ADDRESS \ UNIT <br /> t. 5veer — Mti - -�cJC •pa- G•'{'\ co r. or <br /> 2. So- ? oN C�rr 'l l + o� net J E] Unit <br /> 3. sO O G -7 ( it ( ( p <br /> 4. Srte 7 C $$`( (( c u Unit2 t <br /> 5. sV �'�-0 (t ( ( Q O-l\ <br /> Uni ) <br /> 7. SUM I Ci 7U <br /> S7 <br /> cMCKY EFR 17 2004 <br /> s. s �-`�7 (o r< r <br /> s. so-M 2 S7 T c r( ri ❑ Unit 5 <br /> 10. SUM V (O E: O l ( r ( aty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT )d-SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL DAIRY <br /> �Il HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br /> �-TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKJYARD/CHEM TOILETS <br /> ❑ TATIOOBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 H 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 4842406 - <br /> 8(8f2003 <br />