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REIENED IfriO LOG NUMDLI <br />SAN JOAQUIN COUNTY <br />NO 2 0 2007 <br />ENVIRON1VIENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3rd Floor Stockton, CA 95205 <br />ENVIRONMENT HEAFe 468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin.c3i 2 <br />PERMIT/SEPIVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: A-10121_ get C c.,-, BUSINESS/AGENCY. Aiy:t 1 or A1424ort -4- A-LCOC ti'lC • <br />ADDRESS: 610 2 :Ii4PtAiSh-'14 OUa,-.1 (.,,c7r,e; q C. 2-Li 0 <br />.1 f <br />PHONE: 3L2-1- - 39-D \ FACSIMILE: 3 (.91 - 427- <br />TENTATIVE* APPOINTMENT DATE: \ (-2(f/19 —i- <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 />Time: 9 crO s, <br />SIGNATURE OF APPLICANT DATE <br /> <br />Department Use Only <br />FILE ADyRESS <br />.1, stmei 38.3(.47 t..I . pj./...v.)--i-zyks ‘/ _sly gfirtki-cr, <br />2 Street 393 I N.L2A.A1-1)-N City c...3 9" <br /> Stre61 <br />tx <br />393 I' Ai , PUPV-4) l'-'• City . <br /> Street CI (11 /\•1 r i2A'‘.)-k-0"-\ Guy v.-2g 57c--.2)TD .._ ZD 4, <br />5 Street 3 7'., i\/ , A 0( Pnr -k— City <br />6, Street 4 I 0 c (A.g_5 6) (A) City 9C5 <br />7. Street ,F 3-5 2- /V • i\-)1 .24"Ifvv-, city _ z <br />a, street 3j- f\l,Vi......,......„,,Clly <br />9 Strect 3 ( /'J .. 1N11( C OY City -, <br />10. Slmnt , 3 1,16751.E • CI I CI I <br /> <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES OUGODIEJO C:1 SOLI <br />M SOLID WASTE v CLE <br />In DAIRY <br />O PKG TREATMENT PLANT <br />ni PUMPER TRUCK/YARD/CHEM TOILETS <br />In LAND USE APPLICATION SITES <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />OTHER CLEANUP SITE (NON-LOP) <br />UNDERGROUND TANK (MONITORING/REMOVAL) <br />HAZARDOUS WASTE GENERATOR <br />TIERED PERMITTED FACILITY <br />TATTOO/BODY PIERCING <br />MEDICAL WASTE FACILITY <br />HOUSING ABATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTEUHOTEL <br />pOOUSPA <br />OTHER (PLEASE SPECIFY) <br />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 />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 />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 />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 deposit prior to review. <br />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />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 />M41348-02,006 <br />8/8/2003