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TERRACON - RENO Fax:775-351-2423 Nov 4w9_003 13:47 P.01 <br /> elns� , <br /> SAN JOAQWN COUNTY <br /> END LOG NUMBER <br /> NOV 0 4 2003 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d FlOvr Stockton, CA 95205 <br /> NV1R0NMEN-QftL,t1i4-3420 Fax: (209)464-013$ Web: www.co.sau joaquin.ca.us/ehd <br /> pERM11/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ �1 t`-'IC �r BUSINP-swApENCY: <br /> ADDRESS: 8 -7 WKS MV- <br /> PHO • 51 _2_400 FACSIMILE: <br /> c.au 'I (5-9.50" I <br /> TMENTDATE: AlQV I Time: c� <br /> (Please allow 10 business da"from date of application submittal) <br /> GHE K BOX TO EXPEDI EQUEST-$93.OD FEE—REQUELPROCESSED IN 3BllSiNE35 DAYS <br /> SIGNATURE OF APPLICANT .) :,m DATE {l Y d <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> T, c. Lp IIID <br /> : streetICL V40 O& S1. <br /> aty 01 o Q Unit 1 <br /> unit 2 <br /> W{�AJT 5sT2 "A <br /> R.' � + O 7. SI <br /> 3 . ac <br /> 0. <br /> Unit 4 <br /> cc6jM71 t- <br /> ni#5 \ �7t N,7J�['i?� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> =+yNDBRGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ,�,� <br /> ��HER CLEANUP SITE(NON-LOP) C] F000 FgC1L1TY 0 �0LID WASTE FACT } r' <br /> Q�ifdDERGftOUNB TANK(IVIONfTORIN¢1REMOVAL) ❑ DOG KENNEL SOLD WASTE VEHf <br /> tU Z OUS WASTE GENERATOR Q CHICKEN RANCH M DAIRY '� x <br /> CYTIERED PERMITTED FACILITYcl PKG TREATMENT PLANT <br /> 0 TATrootBODY PIERCING 4 MOTEEJHOTEL Cl PUMPER TRUCKIYARDICHEM TOILETS <br /> 13 MEDICAL WASTE FACILITY El POOLISPA ❑ LANA USE APPLICATION s1TEs <br /> ❑ OTHER(PLEASE SPEq ro <br /> 1• List up to ten addresses In the space above. Select the type(s)Of files frorn the list above by checking <br /> the appropriate bpx(es). At least one the type MUST be selected. Fax to (MI 4 i4.0l38 or mail to t e <br /> addr Icat b ve. <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be eonftrmed <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 an 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 /> 5• <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> "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 <br /> — — —�L�_ TIME �p <br /> DATE CONFIRMED PHONE FAX <br /> INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 4l.62-M <br /> arsnoaa j �� /1J�'Q c�C1rI�5 s ✓- ( } wcC t7s� t f �ll��tJ� -C,10 S t'S f rPsS S 17 S C lGc�-t.L7�f <br /> � r <br /> -5 fie GPS <br /> . I <br />