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­4649/2004 10:23 FAX 209 94p00,21 <br /> X002/002 I <br /> bATr;WF <br /> - ;<<. D <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES a�ocNUMatx. <br /> JUN 0 9 2004 ENVIRONMENTAL HEALTH l]IVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR <br /> ENVIRONMENT HEALTH STOCKTON CA 195202 <br /> PERMIT/SERVICES (209)46"420 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT S;—( L�L!�, eUSINE331AG1=NCV <br /> ADDRESS .�G IZtC- <br /> - ._ <br /> p ` 4 <br /> PRONE kv—a L{a^ FACSIMILE <br /> TENTATIVE*APPOINTMENT DATE f y TIME (z A> <br /> (Please give T to 10 business days from date of application submimai) <br /> + CHECK BOX TO EXPEDITE REQUEST- ,00 REgU STP OCE S ED IN�USIN 5 DAA <br /> SIGNATURE OF APPLICANT - DATE $ f vr ) <br /> fl, <br /> FILE ADDRESS THIS SIDE"D STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> ,.I0 3Q 0 <br /> I <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> •'fir �. 7- ,Wr <br /> IF UNDERGROUND TANIC(UST)CLEANUP SITE LOP 0 HOUSING ABATEMENT T <br /> (LOP) Qi� SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILffY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK.(MONiTORINWREMOVAL) is 100G KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH � PKG TREATMENT PLANT <br /> TIERED PERMrrTED FACILITY ❑ MOTELtHOTEL E7 PUMPER TRUCFK/YAIRDICHEMTOILETS <br /> 0 TATTOO/SODYPEIRCING 0•POOijux (A 'LAND USE APFU CATION SMES <br /> Ci MEDICAL WASTE FACILITY 9 PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ASOvE) <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 (2021 464-01ZB oi;mail,to the <br /> addreo Indicated 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 laterthan ten(10)days after recelpt of.applicatlon. 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 staif-may not be immediately available for review. A nevi <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 Elle reviews by the same applicant may require y8 3 dep0 t'pr revlavy <br /> 5. 'TENTATIVE appointment slates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wil!be processed the next businesdj. ` <br /> CONFIRMED APPOINTMENT DATE. _ _ TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br />