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03/25/2004 17:49 415989993 - ENV5F PAGE 01 <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3N Floor Stockton, CA 95205 <br /> FIVViRONMEK h4 00 468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/ehd 17q7 <br /> PERNIMSERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> �P/P/L�ICATIO. N <br /> APPLICANT; r,, ° BUSINESS! GENGY: �,i[�(/� U _,,T, I'V1/CJ��yI�� /7 <br /> ADDRESS: 2�� 'tN2`I`I�.t'A �fg9k 44LMtz�-�r7CO l7q <br /> PHONE: ��5� t.SL� �`l J l FACSIMILE: <br /> TENTATIVE*APPUINrMLN? UA It: Time; <br /> (Please allow 10 husiness days from date of application submltlal) <br /> 1."1 pr <br /> —V I� <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE-REQUUEST PROCESSED IN 1 BUSINESS DAYS f <br /> SIGNATURE OF APPLICANT DATE <br /> l/ apartment Use Only <br /> ua a FILE ADDRESS UNIT <br /> sm,M /Q noiw ON Unit 1 <br /> It <br /> "4. "svea UdC wP v C 'tv El Unit 2 <br /> �wn A <br /> 6. boot C " ` ' J <br /> L16 2-1 yt cu i / Unit4 <br /> r. 16vren, <br /> 8.U Sheer / 0 Or�1^ C <br /> I LASSheat I -lY c �l Y� <br /> E- ❑ Unit5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT. ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ F000 FACILITY O SOLID WASTE VEHICLE <br /> 29-UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HA2ARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 13 MOIJHOTEL CIPUMPER TRUCKNASIM TOILETS <br /> ❑ TATTOO/500Y PIERCING 13POOLOL�PA O LANG USE APPLICATION TION SITE9 <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the spare 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 12091464-0138 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 he 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 starr 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 Duslness day. <br /> CONFIRMED APPOINTMENT PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 4e4)2-008 <br /> e�zeoT <br />