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03/25/2004 17:49 4159899934 ENVSF PAGE 01 <br /> IND '—E <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 q7 <br /> ENViRONME[J Nk 20b 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ebd 17 <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE A�P/PLICATION <br /> APPLICANT:14h BUSIES/✓GE¢/NG4Y�; <br /> ADDRESS: �84 �t <br /> PHONE:—(fl j5) q� 4 — l l /,3 FACSIMILE: <br /> r <br /> TENTATIVE*AI'I'VIN IMILN I UA I L: 1 ( Time: <br /> (Please allow 10 businsss days from date of application submlttal) <br /> CHECK BOX TO EXPEDITE REQUEST-$9,3,010 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ��i�/ y%� jjq "'^ DATE <br /> epartment Use Only <br /> FILE ADDRESS UNIT <br /> city <br /> nit 1 <br /> ' O 11 s� ❑❑ Unit 2 <br /> Unit 3 <br /> 6. mot C' <br /> C-1 11q <br /> 99i n cn I <br /> Unit <br /> 8. u 1 D r �` _ c:. <br /> 1 �P �` IU ff S ED Unit 5 <br /> 0 1 2 erf' rt of0 C. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Er'UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 13 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 13 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOrBODY PIERCING M POOL1*PA ❑ LANE)USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the-;rire 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(209)464-0138 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 he 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 titelrr 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 EHD 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 4"2-006 <br /> 802003 <br />