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Dq�j 11J EHD LOG NUMBER <br /> lf1iI�� 1� EI� � SAN�)OAQUTN COUNTY It <br /> ENVIRONMENTAL HEALT.EI DEPARTMENT <br /> _Ji'f 0 7 2007 304 E Webcr Ave 3`d Floor Stockton, CA 95205 q <br /> ENbIF50Plil,lc, ��22pp 468-3420 Fax: (209) 464-0138 Web: www.co.san-j oaquin.ca.us/t d I <br /> "ENV f fit�L. <br /> PERMI?/SERVICES PUBLIC RECORDS 1REL)EASE APPLICATION <br /> APPLICANT: p26", V_AA.l_c•-o BUSINESS �IAGENCY: -F <br /> r1GAI � 7Tltii,(,Q.I,S✓f.-� <br /> q <br /> ADDRESS: 1011 2; Iy. J 1N A-°i / <br /> l,.O OU CIS' -q O <br /> .71 •.•. <br /> PHONE' 89 —3-1"D I FACSIMILE:_ 3Le--+ yi <br /> TENTATIVE*APPOINTMENT DATE: (P(l.2-F•(1'+ Tlme: ' <br /> (Please allow 10 business days from date of applicatib <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROC SS DAYS <br /> SIGNATURE OF APPLICANT A h DATE <br /> Department use Onty <br /> (�/1 rFIIL�E,,AOOR:SS r� UNIT <br /> 1. sVeel O. 1 S G ��J-♦t k- T\� GIOA�� 1,15 Unit 1 <br /> 4+OTO E. Y �AMh S;+. GIY COl <br /> 1V\ 3. -street L D <br /> ..r <br /> Qw <br /> Unite <br /> 1 : � <br /> A. street C44:X- kv-t_ CllyLa-A 00 b <br /> s Slreel at L Unit <br /> e. Street '' -oqf'Z 4K0 Unit <br /> P. Slrel IU <br /> GI <br /> \`\\V <br /> ❑ Unit 5 ■`�/�_`, <br /> 16. &unci G � r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> i UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILnY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY C7 SOLID WASTE VEHICLE <br /> UNOERG ROUND TANK(MONIYORINGIREM OVAL) ❑ DOG KENNEL O .DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTELrHOTEL ❑ PUMPER TRUCKfYARD/CHEM TOILETS <br /> ❑ TATT00180DY 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 checkin <br /> the appropriate box(es). At least one file type MUST be selected. Fax to f209)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. e` <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A ne <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 Aaff at the expens <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 /> 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 —I <br /> EHD 40-02-096 <br /> M012000 <br />