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11/17/2004 09:40 FAX 209 9480821 <br />Z002 <br />�� 1��if SAN JOAQTJIN COUNTY <br />ENMONMENTAL REALTR DEPARTMENT <br />NOV 1 7 2004 304 B Weber -Ave 3d Floor Stockton, CA 95205 EiVVIRONiI�' v 1168-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca uslehdZ,3's <br />PFRN"T,/SERVICESpUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: it,. •(N75i.fj BUSINESSIAGENCY: A,.,AIAs <br />TENTATIVE' APPOINTMENT DATE: II130 Time= <br />(Plawe allow 10 business days from date of 11POIC40e submittal) <br />El CHECK BOX TO EXPEDITE REQUEST -$97.00 FEE- REQUEST PROCESSED IN Z.BuSINESS DAYS <br />SIGNATURE OF APPLICANT DATE �Z,7 o r <br />Decarbnent USe OnIY <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />UNrr \� <br />p Unit 1 �l� <br />Unit <br />Q► Unit 4 I T� <br />El Unit 5 <br />w^;+ .(v <br />N <br />9 UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT NL SOLID WASTE FACILITY <br />26 OTHER CLEANUP SITE (NON -LOP) O FOOD FACILITY ❑ SOLID WASTE VEHICLE <br />ID UNDERGROUND TANK (MONTTORINGlREMOVAL) CIDOG KENNEL r4 DAIRY <br />!8t. HAY.ARDOUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT <br />O TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKTYARIUCHEM TOILETS <br />q TATTOO16ODY PIERCING O POOLrSPA LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY O OTHER (PLEASE SPECLF'n <br />1. List up to ten addresses in the space above, Select the type(s) of files from the list above by chackin! <br />the appropriate box(es). At least one rile type MUST be selected. Fax to 209 464.01311 or matt 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 he scheduled <br />a <br />accordingly. . <br />by EHD staff may not be immediately available for review. of <br />3. A rile that Is actively being worked on <br />application may be submitted when the file Jr available. <br />4_ Any file not returned in the same condition as released will be reorganized by EHD staff at the expen- <br />of the applicant. Future rile reviews by the same applicant may require a $93.00 deposit prior to revil <br />S. *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 />TIME :_z ,:._ ..•::.; :.: . <br />IvUNFIRM�D; APRoiNT1AENTI6ATE; - n•; �� <���:,.. ,. �. <br />" `PHONE FAXx vINfTIALS <br />'DA -r CONFIRMED '::'J`...> <br />.REVI•EWED .- YES NO .. REVIEW DATE, . <br />