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63122/2004 17:49 - 415989 934 ENVS �� -"r A <br /> i�PAGE 01 <br /> clv�W Ff - <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT I <br /> 304 E Weber Ave 3"d Floor Stockton, CA 95205 <br /> ENVIRONMEIJ EiOM468-3420 Fax: (209)464-0138 Web: wr" a,v�,,Go.san joaquin,ca.w/ehd <br /> PERMIT./SERVICES <br /> 17 7 <br /> d .E <br /> PUBLIC RECORDS RELEASE APPLICATION I <br /> APPLICANT: SUSINE551 <br /> ADDRESS: f� "1 �IrL �I ✓L/"! 'f/I/I �[ CQ ' <br /> PHONE: FACSIMILE:.: <br /> TENTATIVE*APYUIN I MILN I UA I k: � � Time, <br /> (Pleana allow 10 businass days from date of application submittal) t <br /> CHECK BOX TO EXPEDITE REQUEST-$9_3.000 FEF;-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF.APPLICANT �i y i''^ DATE <br /> f apartment Use Only <br /> 4 <br /> FILE ADDRESS UNIT h <br /> 615)nP c <br /> a f L(trC G(lL Unit 2 <br /> ch <br /> W"4#117-0 <br /> rr. Llnit 3c Y1 oi� unittr` c <br /> ,o. t rt Al tF 35 ❑ Unit 5 <br /> t161q2-67- 2r <br /> ENVIRONMENTAL 14EALTH DEPARTMENT FILES —_ <br /> I <br /> CUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ASATEM01-, ❑ SOLID WASTE FACILITY <br /> t l OTHER CLEANUP SITE(NON-1.0131 M FOOD FACILITY O SOQE)WASTE VEHICLE <br /> JE-UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTEE)FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHIFM TOILET$ <br /> 0 TATTOOMODY PIERCING o POOU*PA C] LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 9. List up to.ten addresses in the apace 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 12091464.13S 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 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 j <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 tree same condition as released will be reorganized by EHD stafratt 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. x <br /> CONFIRMED APPOINTMENT PATS TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW[GATE <br /> EHD es-uxaoe <br /> I <br /> etetzuos ' <br /> I <br />