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FROM :Sau San FAX NO. :510-436-4780 08 2003 08:23AM PI <br /> 09105/'.7aa3 11,04 4brJ0F ENVIP&.NE14TAL HEAL* <br /> PAGE 02 <br /> EHD LOO NUMBER <br /> R-)E SAN JOAQUIN COUNTY <br /> ID L-y <br /> SEP 0 8 2003 )ENVIRONMENTAL HEALTH DEPARTMENT 'Oft <br /> 304 E'Weber Ave 3"'Floor Stockton,CA 95205 <br /> ENVIRONMENT tiEALT R09)468-3420 r,ax!(209)4.64-013 8 Web: WWW,c0.9an-joaquin.ca.us/ohd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLIQANT-_-_-.)A\3 AUSINESSIAGENCY: D-V1SIC'C&Y Ft-; rnof-)*:1 <br /> ADORES I Co GTI loy-n' <br /> PHONE, XAC3]MILE. j <br /> W-S- "3 -9C) O,f(,l Ce- <br /> TENTATIVE-APPOINTMAkATE: <br /> (Pl*wA allow 10 business days turn date of application submittal) <br /> CHECK COX TO EXPEDITE RE7!Z_1111.00 F 'REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> Coo <br /> SIGNATURE OF APPLICANT OATE <br /> Dcoartmerl Use Only <br /> FILE ADD UNIT <br /> Cl Unit 1 <br /> 2 <br /> 3owl <br /> 4- sWN1 city <br /> Unit 3 <br /> oUnR4 <br /> We$ (I Unit 5 <br /> Zu <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> AUlkloeRr.ROUND TANK(UST)CLEANUP WE(LOP) 0 HOUSING ABATEMENT n SgLio wAsTE.FACILITY <br /> C131,OTHER CLEANUP SITE(MON-LOP) 0 FOOD FACILITY 173 SOUP WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 000 KENNEL C3 DAIRY <br /> mArmooua WASTE CFN5RA7rOR 0 CHICKEN RANC)i 0 PKQ TREATMENT PLANT <br /> * TIERED PERMITTED FACILITY El MOTFLIHOTEL M PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TATTOO/BODY PIERCING C3 FoOLISPA 0 LAND USE APPLICATION SITS <br /> * MEDICALWA5TE FACILITY 0 MSR(PLEASE SPEC"_—_- <br /> 1. List tip to ton addrQ6%45 In the space above. Select the"(s)of Tilos from the list aboYe by Checking <br /> the appropriate box(es). At least one file type MUST be sel"ted. Fax t_o 209)464-0130 gr maiLtO the <br /> address indicated_above. <br /> 2. E HD will notify the applicant if any EHD files exist. An appoiritmerlt for review will bra confirmed <br /> approximately five businesS days bUt no later than ton(10)days after receipt of application. The files <br /> will be held for a maximum Of five business days for review. Appointments should be schodu.led <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately ayallable for review. A new <br /> application may be submitted when the rile Is available. <br /> 4. Any file not returned in the same condition as r9192604 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 /> S. PTENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be proeasead tho next business day. <br /> co-mFiRmeD APPOINTMENT DATE - 'IME <br /> DATE CONFIRMED -, PHONE FAX INITIALS <br /> R1!VtEW90 YES NO REVIEW DATE <br /> W"dal <br />