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03/25/2H04 17:49 4159P 934 ENVSF PAGE 03 <br /> i L EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2 6 2004 ' ENVIRONMENT&L HEALTH DEPARTMENT <br /> 304 E Weber Ave 3"� Floor Stockton,CA 95205 "Iqq <br /> ENVIRONMENTER Tj�68-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICE <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r BUSINESSfAGE CY: �' " ZfIla e/-7¢ _ <br /> ADDRESS: Q <br /> PHONE: u l FACSIMILE: <br /> TF_NTATFVr! APPOINTMENT DATE: <br /> (Please allow 10 buslnoss days from date of appllcatlon submittal) <br /> CHECK BOX TO EXPEDITE REQUEST.$93.00 FEE—REQUEST PROCESSED TN 3 BUSINESS DAYS <br /> SIGNATURE OP APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS uNtr <br /> 1, sn Q(C city f ? LJ 0 Unit 1 <br /> O <br /> A <br /> $� �� V m ❑ Unit 2 <br /> .. ss 0_7– 147-4 'i OLY <br /> y-y- <br /> s JOS' u Unit 3 <br /> 35a /H 2= <br /> s Z Z W d+?f2 C <br /> Unit 4 <br /> g. it c a ❑ Unit 5 <br /> 10. of 0 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,i <br /> ZUN❑ERGROUND TANK(UST)CLEANUP SITE(LOP) D HOUSING ABATEMENT Cl SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ;r '❑ FOOD FACILITY ❑ SOUD WASTE VEHICLE <br /> f UNDERGROUND TANK(MUNI I ORINGIREMOVAL) C3 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M PKG TREATMENT PLANT <br /> I ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUC:KlYARDMtIEPA TOILETS <br /> 0 TATToo/moDY r'IERCINC d POOL/SPA 17.1 LAND USE APPI.inAyintl Rrms <br /> ❑ MEDICAL WASTE FACILITY 0 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 4UA138 or mail to the <br /> address Indicated above. is <br /> 2. EHO will notify the applicant if any EHD files re <br /> exist. An appointment for view 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 expar+sc <br /> of the applicant. Future file reviews by the same applicant may require a$93.06deposit prior to review. <br /> S. *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 PRONE FAX INITIALS <br /> REVIEWED YES NO '' REVIEW DATE <br /> EHD 40-09— <br /> arertaoa <br />