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03/25/2004 17:49 4159899934 ENVSF PAGE 01 <br /> Fol�r--- �f� �+ <br /> LF St C— VED§�L_I <br /> SAN JO,AQUIN COUNTY - <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 q"7 <br /> EWIRONMEfff H400y468-3420 Fax: (209)464-0138 Web: www.co.san-joaqu.fin.ca.us/ebd 17 <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: pal )/f�� w BUSINES51 GENCY; <br /> ADDRESS; �r( � (/ �(7C� <br /> PHONE: St_�, FACSIMILE:�_{_l %J. 1j3q—._qq <br /> qfr <br /> TENTATIVE*AYPUINrMLNI VAIt: t��&,46 � rime; !2'tqV A-f4't <br /> (Please allow is business days From data of applicatlon submittal) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$9,3,00 FEE—':REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTG '' DATE <br /> epartmertt Use Only <br /> FILE ADDRESS UNIT <br /> +• y10 Q p <br /> a• ( F_�,Cc u C � /S.S' nit 1 <br /> 1 <br /> �11'C wP c '( on I 02 Sa / Unit 2 [[ <br /> s. o� ,( <br /> c <br /> n . AM z Unit 3 �d�-4) <br /> ! <br /> Ch Unft <br /> I ° It AJff s ❑ Unit <br /> 2 <br /> ,a. 1 2f' P7 ON <br /> ENVIRnNMENTAL HEALTH DEPARTMENT FILES <br /> Jff'UNDERGROUND TANK(UST]CLEANUP SITE(LOP) 0 HOUSING ABATEMENT. ❑ SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY 0 SOLID WASTE VEHICLE ! <br /> Zr-UNDERGROUND TANK(MONITORING/REMOVAL) R DOG KENNEL 17 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS i <br /> is TATTOoraODY PIERCING D POOLJCPA L7 LANQ USE APPLICATION SIT" <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the npaCp 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 2091 464-0138 or mail to the <br /> address indicated above. <br /> 2. EH17 will notify the applicant If any EHE]files oxist. An appointrnent for review will hk-confirmad <br /> approximately five business days but no later than ten(10)days after receipt of application. The files <br /> I <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 I;HD 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 sante condition as released will be reorganized by EHD sLarr at the expense <br /> of the applicant. Future file reviews 6y 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"Z-006 . <br /> erareuw <br /> i <br /> r <br />