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03/25/2004 17:49 4159899934 ENVSF PAGE 01 <br /> - _U' SAN JOAQ UIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber live 3 d Floor Stockton, CA 95205 q47 <br /> EI ViRONMMT H400Y468-3420 Fax: (209)464-0138 Web: www,co.san-joaquin.ca.us/ehd 17 <br /> PERN1':T/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: w BUSINESS/AGENCY; /!/� U <br /> ADDRESS:/r� �� `� DI r ' ✓!/"'' 'vvC �CO <br /> PHONE: ( "1(S) qq 33 FACSIMILE: C f.(�/ f 0q- ( f 31 <br /> r r�. <br /> TENTATIVE*AF'F'UIN I'MLN I UA I L: Time; <br /> (Please allow 10 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE–REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4�s�i�i(J - � z"'^ DATE �T <br /> Partment Use Only <br /> FILE ADDRESS UNIT <br /> C nit 1 <br /> 3. OL-1-17rdh 5f, oty1L s0 <br /> Unit 2 <br /> SSI <br /> so. 2 L� c Unit 3 <br /> 6. <br /> ,dtlIq <br /> et C , ,. <br /> �. et i t1 PiA P b(411 c" � Unit <br /> e. <br /> &t/1 D I Ce4170r c <br /> I -& C -IV �c JUif S ❑ Unit <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1B'UNDERGROUNI7 TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT. ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) C1 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> D TATTOOrsooY PIERCING O POOLIUPA G LAND USE APPLICATION StTE9 <br /> ❑ MEDICAL WASTE FACILITY d 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(209)464-013. 9 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHD filos oxist. An appointment for review will ho 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!starrat 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 PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHO 4"2-006 <br /> IM12003 Y <br /> a,; <br />