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03/25/2004 17:49 4159899.9934 ENVSF PAGE 01 <br /> D -- <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'j Floor Stockton, CA 95205 q7 <br /> ENVIRONMENT HkI2OY468-3420 Fax: (209)464-0138 Web: www.co-san-joaquin.ca.us/ebd 17 <br /> PERMR/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION ' <br /> APPLICANT: BUSINESS! GyE�NCY;Y: <br /> ADDRESS:r `�'1 <br /> PHONE:- ( flf 5 FACSIMILE: <br /> TENTATIVE"AFFUIN I MLN I UA I t: 1 ! Time: <br /> (Please allow 10 businsss days from date of application submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST.393.000JFEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT /`2si�j�/ s &'-;f17 DATE <br /> apartment U9e Only <br /> FILE ADDRESS UNIT <br /> C nit 1 <br /> Unit 2 <br /> ami UQ c " Unit 3 <br /> r t1�1 C�7 <br /> 6. of C <br /> 14 Unit <br /> 1jip C �` Al J+� S ❑ Unit 5 <br /> ,o. <br /> *00112- qe of c, <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> JJ'rUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT, ❑ SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOI-ID WASTE VEHICLE <br /> ,0-UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ UAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCWARDICHEM TOILETS <br /> C3 TATTOOMODY PIERCING ❑ POOLI*PA M LAND USE APPLICATION Sn£9 <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the glace above. Select the type(s)of files from the list above by Checkinq <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0738 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant If any EHD files oxist. An appointment for review will hp 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 Nurr 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 EMD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-03-006 <br /> RN2003 <br />