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03/25/20e4 17:49 . 4159899934 ENVSF PAGE 03 <br /> \j <br /> �}F� �1IfEO� EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> MAR 2. 6 2004 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENNONMENT304 E Weber Ave Ya Floor Stockton,CA 95205 <br /> PERMIT/SERV� <br /> I E6,,§�468-3420 Fax:(209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> I ES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 9-� .6;t&4 BUSINESSIAPENCY: e,-7 <br /> ADDRESS: <br /> 4 <br /> PHONE: FACSIMILE.' 61750- <br /> TENTATIVE"APPOINTMENT DATE. <br /> L <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> TDATE <br /> V Department Use Only <br /> FILE ADDRESS UHC"1, 19 <br /> c. Street Cl/ 'Da C3 Unit 1 <br /> -�Ogr4- IOU4-11 "k�'T N-4 <br /> 3. $1.1 C41Aflotr OfAed- - Lk S-r'N '-4 Unit 2 <br /> 4. Street CA, Uj All <br /> S. Street Otv <br /> e. street 2�xz Weber APeiff" E4,51'- cy LAS 7- Unit 3 Cid <br /> Lt0. ot�t 1W '-4red- A . A 411111111111h.. <br /> 6"01 firf I EL Do p -'Xw C* VST. set 205- CAU40- - E4-k crty'ttST -A"-,I Unit 5 <br /> West 53Z2 M. "rec_ My L)� <br /> U%wy- 56ut-kk [As-r ,-�j <br /> ENVIRONMENTAL HEALTH D-PARTM <br /> i a F 1� 1 3 <br /> ZUNDERGROUNO TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT Cl SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 $QUO WASTE VEHICLE <br /> ,0 UNDERGROUND TANK(MUNI I 0HINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 pKe TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY M MOTELIHOTEL 13 PUMPER TRUCK(YAR=HEM TOILETS <br /> 0 TATTOOIBODY PIERCINC 0 POOL/SPA 171 LAND USE APPI.IrATInN 4trrFq <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) I <br /> 1. List up to ten addresses In the space above. Select the fte(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)4640138 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 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 III the salne 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. <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 /> -IFFO—404k4% <br />