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03/25/2004�El <br /> 17:49 41598gQ934 ENVSF - PAGE 03 <br /> I� I' E�Elt1 � �I F'[ � i�>,/ L-4 _J <br /> SAN JpAQU1N COUNTY EHD LOG NUMBER <br /> - <br /> MAR 2 6 2004 ENVIRONMENTAL REAETH DEPARTMENT <br /> ENNONMENT 3U4 E Weber Ave 3m Floor Stockton,CA 95205 <br /> PERMIT/SERV 468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: n 6r;5Af " V BUSINESSIAGE CY: v_11t Q®7 <br /> ADDRESS: <br /> PHONE: [ �((�/`"( v�^"('�( J J FACSIMILE:' <br /> ACSIMIILE <br /> TENTATIVEf %fJ� <br /> "APPOINTMENT DATE:�(.Gx <br /> (Please allow 10 business days from date of application submittal) <br /> Q CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAY$ <br /> SIGNATURI°OF APPLICANT 4/ z .,r,�L- J-/,e DATE <br /> Department Use Only <br /> FILE ADDRESS UNrr <br /> 1. $n Qir city 01& ❑ Unit 1 <br /> z. dr n O <br /> s 1 -etr 'J4, at, 0 V ❑ Unit 2 <br /> 4. St I 411arA&L. city <br /> alya MZ �Unit 35 <br /> s1 Z Z W er D� n c. -35Q4 �-.•��. (1dV <br /> °~ _ C n 1- c Unit 4 <br /> 0"Sym <br /> 0. rr cify 3,5QEl Unit 5 <br /> 10. 14t 3 Y c <br /> 7 �'o <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) A HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> UNDERGROUND TANK(MUNI I ONINGIREMOVAL) O DOG KENNEL O DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 13 MOTELlHOTEL Cl PUMPER TRUCKJYARDICHEM TOILETS <br /> E3 TATTOOIBODY MERCINC 17 POOUSPA 177 LAND USE APPI Ir:AT1nIJ SITFS <br /> ❑ MEDICAL WASTE FACILITY U OTHER(PLEASE SPECIFY) <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(209)464-0138 or mail _to the <br /> address 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 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 staff at the exponsc <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 46-o;auG <br /> !/El20Q1 <br />