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uw a�rauuo ♦ r.ua 4D4u1Jo tNVIKUNMtNIALST <br /> TH PAGE 01 <br /> DATE REECENED SAN JOAQUIN COUNTY <br /> o '1�0� ri All ONMENTAL HEALTH DEPART ���� <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 C t \\a L•I <br /> AUG 16 2004 (209)468-3420 (�\Ci J3 J <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> PERMJTI� „ 1 1 '\1J q QS-Q BUSINESS/AGENCY y) Q a Y� ns h� C �� Cl C v� cCE.X <br /> APPLICANT Q:r� p rtec.`�nsiS <br /> S 3 s y <br /> ADDRESS \� <br /> PHONE Z G"\ C> L-�- � FACSIMILE <br /> TENTATIVE"APPOINTMENT DATE :ms \ TIME <br /> (Please give 7 to 10 business days from date of application submittal) 1 <br /> wry/ q3.Ljo <br /> CHECK BOX TO EXPEDITE REQUEST-7"'-" FEE-REQUEST PROCE$SED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> � DATE S 12,\� <br /> THIS SIDE EHD STAFF USE ONLY <br /> FILE ADDRESS FROG FAM ELEMENTS SEARCH <br /> \Zo <br /> \p3 . <br /> an�ar Sk Lop'I <br /> 1"G n tom' Z 9. G> q Nl itd� <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> El FOOD FACILITY El SOLID WASTE VEHICLE <br /> W OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL. El DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O HAZARDOUS WASTE GENERATOR ❑ MOTELJHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOL/SPA ❑ LAND SE AppLipATION SITES / <br /> ❑ TATTOOMODY PEIRCING OTHER(PLEASE SPECIFY) �'� <br /> ❑ MEDICAL WASTE FACILITY <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 (209) 464-0138 or mail to the <br /> address indicated above. ointment for review will be confirmed <br /> 2. EHD will notify the applicant If y EHD files exist. An app application. The files <br /> approximately five business days but no later than ten (10)days after receipt of app <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. EHD staff at the expense <br /> q, Any file not returned In the same condition as released will be reorganized by <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 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. v <br /> CONF1RMEO APPOINTMENT DATE TIME <br /> DATE CONFIRMED <br /> PHONE FAX INMALS <br /> YES NO REVIEW DATE <br /> REVIEWED <br />