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04 / 10 / 03 THU 13 : 02 FAX 925 253 4985 TREADWELL & ROLLO li� 001 <br /> Ell j� i� '� � SAN JOAQUIN COUNTYpUBGIC HEALTH SI� FtV ( CE �► Er1o40GM1lAgER <br /> w 1 <br /> ENVIRONMENTALMEAI,TH DIVISION <br /> APR ho 304 EAST WEBER AVENUE, THIRD FLOOR <br /> 1 0 2003 3q <br /> STOCKTON CA 95202 ( ZCR <br /> ENVIRONMENT HEALTH (209) 4634420 NA "0 Kw% V� z7 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLiCATION <br /> l ) ri n a Hi r►'1sar.�. <br /> APPLICANT BUSINESS CENCY �tf... 4 C) i1Sl <br /> ADDRESS vC TA-f= � ,Al 1J zi o . , ( d�G ___ � 4 <br /> 11C3 �. 5) <br /> PHONE • � L�j- L5 — � iS18C� X 1 F C:SIMU.E <br /> (JVC-111 r+ or ZZ UU <br /> TENTATIVE" APPOINTMEW DATE �y - TIME <br /> (Please give 7 to 10 buslnors days from data of appllcatlon subrnittal) <br /> CHECK BOX TO f_XPEEDITI; REQUEST 9.00 FEE sse )"UJIST PROC6k5ED rNJ BU IN S IAY5�/yy I <br /> L1 <br /> - SiGNATURE OF APPLICANTmsA�/ ^C c <br /> FILL Abl7ttE53 TgfS SIDEENO S'r,4FF USE ONLY <br /> PROGRitM Et.CNIEN sEA V4" <br /> 5 �Jr711 1 F1 -- , <br /> 4 $ b 'rfac c� - <br /> 14 w t6k �i evAg A r� ot, �� r -- <br /> 'i � <br /> 2 31 � T vat tdkt6k <br /> I)1 • v a44fi <br /> Art 9A <br /> 0401 <br /> ENVIRQNIV( ENTAL HEALTH DIVISION FILey <br /> UNC) ERGROUND WANK (UST) CLEANUP SITE (LOP) 0 HOUSING ABATEMENT 0 S1;ll.ln WA5,17E FACILITY <br /> OTHER CLEANUP SITE (NOWLOP) ❑ FOOD FAC Ury ❑ ,! :OLID WASTE VEHICLE <br /> UNbERGROUMD TANK (MONiTORiNGJREMOVAL) • 0 UOG KENNEL 0 DAIRY <br /> HP;ARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 Pli:G TREATMENT PLANK <br /> TIERED PERMIYTED FACiLrrY 0 MOTEUHOTEL ❑ PI.IMPERTRIJC:KNARD(t ;liEM TGIi_ETS <br /> 0 TArrOO113013Y PEIRCWc ❑ P000SPA ❑ UND VSC APPLICATION SiTE5 <br /> O MEDICAL WASTE F.AC:ILI'iY 0 PUBLIC WATER SYSTEM ❑ OTHER (PLIE,ALE SPeCIFY ABOVE) <br /> I <br /> 1 . List up to ton addresses In the space abovo . Select tha types ) of files from t list above by ch © ehing j <br /> the appropriate box(es). At least one file type MUST bo selected. FOX 10 2119],?iGd-p138 or mail to ttL,e, <br /> address indicated above . <br /> 2 . EHD .will notify tho applicant it any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than tett (i0) days atter receipt of applicdtiori. Theriles <br /> will be held for a maximum of five bu$ Iriess ¢ Sys for review. Appolnim cnts should be schodulad <br /> accordingly, y <br /> 3. A file thatJ5i actively bleing worked on by EHD staff may not be immedi :.itely uV;Alldrible for review. Anew <br /> application may be submitted when tho file is available. <br /> A , Any fife not returned 1h the same condition as roloased will be reorg ;Infzed by 1ZHD staff at the expense <br /> of tho applicant . Future file reviews by tho same applicant may require a $ 89 . 00 deposlt • prior to revlew, <br /> s. *TENTATIVE appointment d9les must be confirmed with EHD staff. <br /> ii- Applications received after 3 : 44 pm will be processed the next busines ,; day. <br /> CONFIRMED APPOINTMENT DATE . - -- TIME <br /> DATE CONiIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE '" " <br /> rw <br /> �� JL . , ft , % IrAL -, a (, TntiCl +, Th _ LlT 70P" IT <br />