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Mar • 10. 2003 4:49PM CON#EARTH TECHNOLOGIES NI).3039 P . I/I <br /> ft <br /> pAie - Ir ' I���I [��SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES ernocMuwlSn <br /> ENVIRONMENTAL. HEALTH DIVISION <br /> MAR 1'0 2003 304 EAST WEER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 <br /> c1p,,116JNMENT HEALTH (209) 468-3420 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT,1 d�F[L"F' ay Pl"7_ BUSINE55/AG-NCY •- s _ Q1`����I C <br /> ADDRESS l V�) <br /> PHONE ,y I� FACSWLL.E—I <br /> TENTATIVE"APPOINTMENT DATE !9p arrM TIME 3 <br /> (Pleaa9 2Ne 1 tO 10 business days from date of application eubmittan <br /> rf�---yT 1` ' . �� 5 , 44 <br /> 1__I CHECK BOX TO ECPF.OfrE REQUEST-587.00 FEE-REQUEST"PROCESSED IN 3 BUSW ESS pqY;; /I n � <br /> SIGNATURE OF APPLICANT DATE . -t . <br /> FILE ADDRESS <br /> THIS SIDE EHD STANF � <br /> VSE ONLY <br /> PROGRAM E'LEMEtrTS SEARCH <br /> '15t a,'fftroP V <br /> o0 <br /> r <br /> ( D — <br /> IS�oo <br /> = N <br /> ENVIRONMENTAL HEALTH DIVISION FILEE$ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) q HOUSINGABATEMENT SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONrTORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑-CHICKEN RANCH ❑ PKG TREATMENTPLANT <br /> p+ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCYA'ARDICHEM TOILETS <br /> ❑ TATTOOIBODYPEIRCING ❑ POOL/SPA - ❑ LAND USE APPLICIATIONSITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM U OTHER(PLEA 9:,giPECWYAGOVE) <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. Fa to 2U9 4[tet_O(38 or mail 10 the <br /> address Indleatod above_ <br /> 2. EHD will notify the applicant if any EHD flies 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. Appointment,% should tie 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 EHI) staff at the expense <br /> of the applicant Future file reviews by the same applicant may require a $37.00 deposit prior to roview. <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 />