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03/25/2004 17:49 • 4159899434 ENVSF ��- ! �o�l�F PAGE 02 <br /> RECE n=-1 U% EHO LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave T4 Floor Stockton, CA 95205 <br /> EfdV€RUI�MEi'JT HEA 468'-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.US/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINE !AGENCY: e `�y, <br /> /-ak <br /> ADDRESS: <br /> PHONE: <br /> TENTATIVE*APPOINTMCNT DATC: <br /> (Pleasa allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST•$S3.00 FEE-REQU T PROC SSEDDIIN_4 BUSINESS DAYS <br /> 31ONATURE OF APPLICANT % •. �G 'y DATE <br /> Department Use Only <br /> FILE ADDRESS un�T <br /> C7D k �� ❑ Unit 1 <br /> 3. s+ rlav ❑ Unit 2 <br /> 4. _ T <br /> s. Z0 QV A cr, Unit3 <br /> cr, a� <br /> T. -r! Cj - O Civ nit 4 <br /> e. etre JY tri a& <br /> a e ex O c Unit$ <br /> ,v. s -C, e Z <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I"UNDERGROUND TANK(UST)CLEANUP sl7l=(LOP) d HOUSING ABATEMENT 0 SOLID WASTE FACII IFFY <br /> ❑ OTHER CLEANUP SITE INON-LOP) a FOOD FACILITY O SOLID WASTE VEHICLE <br /> I -UNDERGROUNO TANK(M0KrT0RINWRkMOVAL) Q DOG KENNEL G DAIRY <br /> O HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 0 PUMPER TRUCKfYARAICHEM TOILETS <br /> O TATTOOIOODY PIERCING r, POOL/SPA ❑ r AN (mr-APPI 1116TtON RITES <br /> O MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List uo to ten addresses In the space above. Select the type(s)of files from the list above by checking <br /> the appropriate boxies). At least one file type MUST be selected. Fax to(2091464-0138 or mail to the <br /> address indicated above. - <br /> 2. F..Hn wlll nntify the applirant 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 PHI)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 sande condition as ralemsed will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> S. Applications reeeivea after 3:00 pm will be processed the next business play. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PRONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 4EA�A6C <br /> &Et I <br />