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__-43/24/2004 10:35 FAX 209 9480621 IN02/002 <br /> E R 1VED I - <br /> ° SAN JOAQU*IN COtJNz"X <br /> ENrvjRoNAwNTAL HEALTH DEPARTlV1E <br /> MAR 2 4 2004 - 304 E Weber Ave Yd Floor Stockton,CA 95205 <br /> (209)458-3420 Tax: (209)464-0138 Web,www.co.san_joaquincaus/ehd <br /> ENV RONIVIENI HEN[i h <br /> PERMIT/SERVICES PUBLIC'RECORDS RELEASE APPLICATION <br /> AppLICAIR; Fr4s3t!_S x QeQ n/ BU$INESslAGENCy; A(leov <br /> ADDRESS. a�8as' -f s�oC�7r7KJ �a <br /> PHONE: FACSIMILE. ao9 -- 9y — o t <br /> POINTMENT DATE: q D rW►,e• //=00 �I �� <br /> 'TENTATIVE'AP <br /> (Please allow 10 business days from date of application submittal) fit' <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS ` \� <br /> SIGNATURE OF APPLICANT 7 �l/J � DATE 3 <br /> Deoactrnen Use Only <br /> D FILE ADDRESS UNIT <br /> 1. ! S�� G'e oA� rL Rf off/ [� Unit 1 Jl <br /> 1 sue x so t �1 def:-rme c <br /> 3. sMeei q 1(0 IV <br /> s. s 32 F G e_N U <br /> S. simet q 39 `/G a Unit <br /> 6. d <br /> 7. Chi I,)nit 4 <br /> Suede. Sirocity /O <br /> 9. Steil ❑ Unit 5 <br /> 10. uYeet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT' ffi( SOLID WAS17 <br /> =F 7 0 <br /> OTHER CLEANUP Sn-E(NON-Lop) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> fir UNDERGROUND TANK(MONRORINGIREMOVAL.) ❑ DOG KENNEL 0 DAIRY <br /> }� HAZARDOUS WASTE GENERATOR <br /> CHICKEN RANCH 34 PKG TREATMENT PLANT <br /> ❑ TIERED PERMrrTED FACILITY ❑ MOTELMOTEL O PUMPER TRUCK/YARDfCHEM TOILETS <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SFA LAND USE APPLICATION Slims <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)464-0138 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, Afile that is actively being worked on by EHD-staff may not be immediately available for review. Anew <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$93.00 deposi o o W. <br /> 5. "TENTATIVE appointment dates must be confirmed with EHD staff. t <br /> 6. Applications received after 3:00 pm will be processed the next business <br /> -Cts+)1j�,LF IVIEDJ� OOINTMENTDATE: TIM <br /> ice_• , e'?.,. <br /> '}PHONE . a.' N>�. ..•S <br /> DATE.CONFIRR:E'b FAX -- <br /> 'R"EWjiD YES 'NO REVIEW QA'TI. <br /> EM 4"24" <br /> &=003 <br />