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I, 1-/13/2004 13:57 FAX 209 9480821 �] '- <br /> _ :.: 002 <br /> rhe ' EMU LOG NUMUCR <br /> HATE <br /> W11CR V E�N JOAQUIN COUNTYPUBLIC HEALTH ERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> JAN 13 2004 304 EAST WESER AVENUE,THIRD FLOOR <br /> i <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209)468-3420 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 016�,911 <br /> APPLICANT ` � �' �" �i4'� SUSINESSIAGENGY <br /> ADDRESS . <br /> PHONE �yg, /3 FACSIMILEr <br /> / f/ M <br /> TENTATIVE'APPoINTMENT DATE / p TIME / ! � <br /> (Please give 7 to i0 business days from data of application submIttai) <br /> CHECK BOX TO E7CpEDITE REQUEST-587.00 FEE-RE UEESSTT PROCESSED IN 1 BUSINESS DAYS <br /> w <br /> SIGNATURE OF APPLICANT f . :�'/ DATE �/ /3 /v <br /> dr <br /> FILE ADDRESS THIS SIDE EHD STAFF U L , <br /> PROGRAM ELEMENTS SVAqCH <br /> $ SLc/. Z-4,0.5 p ve-+4c R:ro-, G,q <br /> /$2-S W. Sp.#,4vs i4�e.,c.e <br /> 725 pojccu;Id Av ,t.c 5 4�On ca <br /> C' <br /> • k <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> Ja , <br /> pr UNDERGROUND TANK(UST)CLEANUP SIT€(LOP) HOUSING ABATEMENT J�5OUD WASTE FACILITY <br /> MOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILrrY �SOt]D WASTE VEHICLE <br /> UNDERGROUND TANK(MONrroRINGlREMOYAL) d DOG KENNEL PDAIRY i <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH IM PKG TREATMENT PLANT ! <br /> TIERED PERMITTED FACILfTY ❑ MOTEtJHOTEL ❑ PUMPER TRUCK fYARDICHEM TOILETS <br /> ❑ TATTOOfRODY PEIRCING D'F45OUSPA "' LAND USE APPLICATION SITES <br /> 1W MEDICAL WASTE FACILITY P,PUSLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) ; <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 alppropriate box(es). At least one file type MUST be selected. to 209 464-0 8 or mail to the- <br /> address <br /> headdress indicated above. . <br /> 2. END will notify the applicant.if any EHD files exist. An appointment for review will be 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 nes <br /> application may be submitted when th®Yile is available. i <br /> 4. Any file not returned in the same condition as released will be.reorganixed,by EMD staff at the expetls <br /> of th13 applicant. Future file reviews by the same applicant may require a SS7.00 deposit prior to revie, <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 51 t <br /> 6. Applications received after 3:00 pm will be processed the next business da f, t4. <br /> I <br /> CONFIRMED APPOINTMENT DATE TIME <br /> GATE CONFIRMED PHONE FAX INITIALS <br /> I <br /> REVIEWED YES NO REVIEW DATE <br /> PW m u "m7na <br />