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7 2004 b646PM Nei Anderson & Assoc. No •4226 i--"!P 2 <br /> SAN JOAQU1N COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 1 7 2004 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> ENVIRONMENT I'fENtf�68-3420 Fax: (209) 464-0138 Web: wvrw.co.san_joaquin.ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ( L.G(.'0 BUSINESS/AGENCY: Q <br /> ADDRESS: ! 02 1vvo�US -6L_ "l i 114 <br /> PHONE: 'Jl¢� "3�� FACSIMILE: 30 - LfZ28 <br /> TENTATIVE`APPOINTMENT DATE: 31 ! Time: tn� <br /> (Please allow 10 business days from date of application submittal) - <br /> 17 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 2 111 D-t <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. Street 33 W• Sk- �� �' ❑ Unit <br /> 2 svee 2-30 Indu'•s'1Y- ` ct Q i 6N-\ (7 <br /> 3. "'i 2 Z 3 W Wf�S ! city Unit 2 �• 1 <br /> '.1 <br /> 4. Street 2 S Ij- ru v� C' <br /> s sUeet g3cn-F� City R� wI r_ 2 Unit 3 /LI <br /> s. strdll 10 ' S'E �St"It 85'D iy• Ih'l lg.. d ; nit 4 �► <br /> 8. Street 33 LLE• Y1y1�K:►� S k • — �1 a �.� w <br /> 9. Str et 3 t L- •`�--�'� S� •��{ ', \ GI �t D El'1 ❑ Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 114 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> YJ OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> A UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY C> <br /> i-t HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILET: <br /> ❑ TATTOO/BODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 checkil <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to thr <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 file <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 r <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 expel ' <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to rev <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 /> EMD 48-02-006 <br /> &'88063 <br />