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\ TERRRCON - RENO —Fax:775-351-2423 Nov 4 2003 1347 P.01 <br /> 1� <br /> fI / 11W 1 V��l�� EHD LOG NUMBER <br /> rz -= SAN JOAQUIN COUNTY <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"d Floor Stockton,CA 95205 I `/'✓ <br /> -NVIR0NMEI`d-f4RA0&-3420 Fax:(209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �d MC.lree+ BUSINESWAGENCY: T�-IZ-��.0,C,0 <br /> ADDRESS: /3 80 6(af-6 S-C # 233 S PAV ICS tJV Mgtt:g Q' •!• �t 0nr► <br /> PHO • .SI^2` 00 FACSIMILE: �'TS- 3S1-2t(Z3 � <br /> c.a.A-Q T1s-aso- t 1 <br /> ENTDATE: -T"rt� tj W tj Time: a'1IIL� <br /> (Please allow 10 business days from data of application submittal) <br /> Its CHECZ�K7f BOx TO EXPED pUE3T//--51�93.��00 FEE—REpUE PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I,Yl1W rn DATE —I I `( o-ZS <br /> Dep6rtmcnt Use Only <br /> FILE ADDRESS UNIT <br /> 100S. S ^f, c 11-0:0-1 <br /> awe10 V3 QW& $ t a DZ q Unit 1 <br /> r. el s'Y, ci 1. <br /> o2 C UJAL&UT S?. o It <br /> s Uni <br /> i. 91.W Q 5 G 1 , <br /> 1, Unit 4 z/ <br /> B. 6veM ®� 5� C I t' _ V <br /> 8 ❑ <br /> . 8ua t (�'LtJv I 11 I' <br /> +o. 6+2a Dt GCTrCRR4 PW('t t: Unit5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 JUNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT EYSOLID WASTE F { <br /> HER CLEANUP SITE(NON-LOP) ClFOOD FACILITY C1SOLID WASTE V gE <br /> DERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL C3 DAIRY J <br /> =HAZARDOUSRMWASTE GENERATOR ❑ CHICKEN RANCH C3PKG TREATMENT PLANT <br /> EKED EKED PEITTED FACILITY ❑ MOTEL1HOTEL O PUMPER TRUCKrYARD/CHEM TOILETB <br /> CI TATTOO/BODY PIERCING d pOOLJSPA ❑ LAND USE APPLICATION SITESO MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type(s)of riles from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209146"13"r mail IQ the <br /> ddd esaTndlcated.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 riles <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 II-1:3 TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD N-07d06 <br /> 0oi <br /> 11-$0-3. Noac(e ss fDr Ch v wct .1� urs -�io5es t-�r .;, s 17 5 r jSf <br /> CPQ 3�z M�Gez• Will <br />