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03/25/2004 17:49 4159899934 - ENVSF - PAGE 02 <br /> FD � 1•'1, -- L� , EHO LOG NUMBER <br /> LI U LLL��� ECEIVEIy-- SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'd Floor Stockton, CA 95205 <br /> ENVIRUNNIE J I iiLA_4h9)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/chd I <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATIOgN/ �y <br /> APPLICANT: /,,( ' "B�USIN_EJ�4/-SIAGENCY: V�y" le" r <br /> ADDRESS: <br /> PHONE: FACSIMILE: { ( /�/./�1-��L7�,`,/�J <br /> TENTATIVE*APPOINTMCNT DATE :l i` ' " lma: <br /> (Please allow 10 business days from data of application submittal) I _ 2014 <br /> CHECK BOX TO EXPEDITE REQUEST-$93.0,0 FEE-REQ/UF�IT PROOC/SSEDDIIINNN BUSINESS DAYS <br /> 31ONATURE OF APPLICANT i4 '�L'G'L• �f�G� C.f!'1�U�iZ DATE •�/r " <br /> Department Use Only <br /> FILE ADDRESS c :ILE W,1116x) Unn' <br /> "Sn". <br /> � H E( 0 � D (d ci ❑ Unit 1 <br /> 2 (' O L/ ❑ Unit 2ZCJ i-P <br /> CV c cj� Uri 3 <br /> c� sv.xUS <br /> Q c <br /> Uce`em On _I C - O c. nit4 <br /> USe. easx D - a D Units <br /> oto sm1 Y.t tPir zv" <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES APR 12 2004 <br /> rerUNDERGROUND TANK(USI)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY O SOLID WASTE VEHICLE - <br /> * HA7ARGROUNDTANK(N1ERATO INWREMOVAL) ❑ DOG KEN RA O DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O MOTELIHOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS ftl�b!ii <br /> ❑ TATTOOIGODY PIGRCINO rl POOLISPA ❑ I ANn I ICF APPI ICATInN RrrFS <br /> ❑ MEDICAL WASTE FACILITY Cl 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(2091464.0138 or mail to the <br /> address indicated above. <br /> 2. - FHn will nntify tha applicant if any EHD Hiles 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 FHD 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 cxpcnsc <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 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 /> DATECONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> WD 4942-0 <br /> m(2003 <br />