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03/25/2064 17:44 41599934 ENUSF r PAGE 03 <br />' <br /> IN <br /> SAN JOAQUIN COUNTY EHO LOG NUMBER <br /> MAR 2 6 2004 ENVIRONM.ENTAC.IUA.LTI3 DEPARTMENT <br /> ENVIRONMENT F 3U4 E Weber Ave 3'j Floor Stockton,C:A 95205 <br /> PERMIT/SERVjO 468-3420 Fax: (209)464-0138 Web: www.co.sanjoaquin.cams/chd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: n BUSINESSfAGE CYf <br /> ADDRESS: f G/-G�f j � c <br /> PRONE:_ ( �(l J/`"i +!„l ^�� FACSIMILE:—-p 16 <br /> TENTATNE"APPOINTMENT DATE: <br /> (Please allow 10 buslnoss days from date of application submittal) <br /> i <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE REQUEST PROCESSED IN 3 BUSINESS DAY$ <br /> SIGNATURE OF APPLICANT 441,7 � � � DATE <br /> Department Use Only <br /> FILE ADORESS VNrr <br /> I. Sr t cE C*5 - Sl& L/,' Unit 1 <br /> Vo,4' -etr f ')0 c V rA p Unit 2 <br /> 4. s, r a m <br /> S. , W W00c, u a /ham Unit 3 5 <br /> r. N` ILIQ f44,tc /v Vnit 4 <br /> $. -ft El Unit 5 <br /> 7 a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ZUNDERGROUND TANK(UST)CLEANUP SITE(LOP) A HOUSING ABATEMENT Q SOLID WASTE FACILITY � <br /> ❑ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOL.ID WASTE VEHICLE <br /> UNDERGROUND TANK(MVNII l'HINWRFMOVAL) 4 DOC,KENNEL ❑ DAIRY <br /> a HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH C7 pKG TRF-ATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY M MOTELMOTEL ❑ PUMPER TRUCKrYARWCHEM TOILETS <br /> E3 TATTOOA300Y r4ERCINC ❑ POOLISPA n LAND uss APPOCAWIN SITFS <br /> ❑ OTHER(PLEASE SPECIFY) <br /> 13 MEDICAL WASTE FACILITY � i <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(2091464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHO will notify the applicant if any END 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 Hies <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 the not retumed in tine sante condition as released will be reorganized by EHD staff at the exponso <br /> of the applicant- Future file reviews by the same applicant may require a$93.00 deposit prior to review. y <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 /> I„o 4"z— <br />