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03/20/2003 10:06 20933453 WGR SOUTHWEST NO(* PAGE E12 <br /> i N1 <br /> SAN JOAQUIN COUNTYPUBLIC HEALTH SERVICES .- <br /> IN 111 <br /> ENVIRONMENTAL HEALTH DIVISION <br /> MAR ?, 0 2003 304 EAST WEBER AVENUE, THIRD FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMEN I (209) 468-3420 I <br /> c <br /> SERVICC.� <br /> PERMIT/. PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT r�JJ 'Q, I BUSINES.SIAGENCY W - 5G#CjtL 'P21- <br /> ADDRESS �I [ 5 � �i n P Sri SU i 1y �ma <br /> e ^ y, , ( <br /> PHONE�O�- ^� j ELN ' 6 FACSIMILE (7-0�^ <br /> TENTATIVE"APPOINTMENT DATE TIME <br /> (Please give 7 to 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REq ST-$89.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAY.^, <br /> SIGNATURE OF APPLICANT i/-wA_ �o DATE <br /> FILE ADDRESS THIS SIDE EHD STAFF USE ONLY <br /> PROGRAM ELEMENTS SEARCH <br /> $ 01 L(�R4A +pn�iocfCEosjC 1 - <br /> T_ <br /> ENVIRONMENTAL HEALTH DIVISION FILES p <br /> D�$UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 12 WASTE FAC ILII � m' <br /> .a+ <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY ❑ SOLID WASTE VENICE i s ' D �, <br /> CI UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL ❑ OgIRY9 "`"' <br /> i$HAZARDOUS WASTE GENERATOR f_l CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> R TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCICYARDICHEM TOILETS <br /> ❑ TATTOOISODY PEIRCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM ❑ OTHER(PLEASE SPECIFY ABOVE) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files frorn the list,above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax toM09 464;D138 Or mail to t), <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 expense <br /> of the applicant. Future file reviews by the same applicant may require a$39.00 deposit 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 defy. s <br /> , s <br /> CCM1i I,I IIIIE APP OINTMENT'DAT'.E TIME <br /> F� t)NFIf7M '17:. PHONE FAX INITIAL!" <br /> i? fldlwWED YES NO REVIEW DATE <br /> W _ �_•.....,. <br /> EH01801-006 ' <br />