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03/25/2004 17:49 4159299934 ENVSF iP PAGE 03 <br /> ,C) r -151 <br /> - h EHO LOG NUMBER <br /> SAN JOAQUIN COUN'T'Y <br /> MAR 2 6 2004 RNVIRONMEN'X'kL HEALTH DEPARTMENT <br /> I' ENVIRONMENT 304 E Weber Ave 3'a Floor Stockton;C:A 95205 <br /> STj468-3420 Fax:(209)464-0138 Web: www.co.sanjoa4uin.cams/ehid <br /> PERMIT/SERVI ES 11, <br /> �� <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGE CY: , v ZV ef`f _ <br /> ADDRESS: 5 i �� nbiiA (' <br /> i PHONE:. �"(1 ��! _FACSIMILE: ( '^ <br /> TENTATIVE"AFPOINTMENr DATE; <br /> 1 (Please allow 10 business days from date of application submittal) <br /> ,I <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED fN 3 BUSINESS DAYS <br /> } SIONATUR12 OP APPLICANT � � � DATE <br />� I <br /> Department Use Only <br /> I <br /> FILE ADDRESS !i G uNtr <br /> a ❑ Unit 1 <br /> /kCIL, 44D <br /> 1)01 a (/Itit <br /> Unit 2 <br /> r. aa�s <br /> Unit <br /> asW GrOft , 35 <br /> rr C e)[ o I <br /> 11: <br /> C <br /> 9. ❑ Chit 5 <br /> ,ae3 t c <br /> 124 Cht7.� 35s$/c.O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />{ ZUNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT i 0 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY I D!SOOE)WASTE VEHICLE <br /> I 13'UNDERGROUND TANK(MUNI I0HINGIREnsOVAL) ❑ DOG KENNEL ! M DAIRY <br /> O HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH i' ❑ PKG TREATMENT PLANT <br /> D TIERED PERMITTED FACILITY C] MOTELMOTE[. !I 0i PUMPER TRUCKJYARDICHEM TOILETS <br /> ❑ TATTOo/noCY PIERCING ❑ POOLISPA rl LAND USE APP13CATIC1W RITES <br /> E3 MEDICAL WASTE FACILITY L7 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 MAST be selected. Fax to(209)454.0138 or mail to the <br />{ address Indicated above. I� <br /> 2: EHO 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. j} I <br /> i 3. A file that is actively being worked on by EHD staff may not be Immediately available for review. A new i <br /> application may be submitted when the file is available. it ;'p <br /> 4. Any file not retumed in Lhe carne Condition as released will be reorgdnized by EHD staff at the oxpon= <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 /> f G. Applicatlon5 received after 320 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIFtMED PHONE FAX INITIALS <br /> II <br /> REVIEWED YES NO REVILIW DATE <br /> L"D 46.09-MG <br /> weam <br />- Y <br />