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07/20/2005 WED IL44 FAX 20946- '19 SJC PUBLIC WORKS <br /> fool ooI <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEri T�SMONT <br /> JUL 2 0 2Q05 304 B'er Ave 3rd floor Stockton uin.ca rile <br /> 209)468-3420 Fax: (209)464-0138 Web:www-co,sau joaq <br /> ENVIRONMENT HEALTH PLIC RECORDS RELEASE APPLICATION <br /> PERMWSERVIC <br /> APPAPPLICANT:caN <br /> iaudia Gemberling BUSINESSIAGENCY: San Soaquin County Public works Department <br /> ADDRESS: 1810 E. Hazelton Avenue, Stockton, cal46812999 a 95205 <br /> PHONE: 953-7624 FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: rine: <br /> (Pleaso atbw 10 businaas daYs from date of application submittap '1 <br /> © CHECK 84X T4IXPEDTTE RF.QUES'r•:9�U�A� Qp 1NESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT Dapanrwnt Us Only <br /> UNIT <br /> ►Aa c4mtP <br /> iFILEt_LE ADDRESS J qs Unit <br /> l3a Unit <br /> Do c Unta <br /> Unt4 <br /> ,. ❑�pUNt5 <br /> � <br /> � O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIL40G <br /> UNDERGROUND YANK(USTI CLEANUP SITE(LOP) 0 HOUSING ABATEMENT rw SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NONA.OP) O FOOD FACILITY 0 WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) DAIR DOG KENNEL DAIRY <br /> �t HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH PUMPER TRUCK(Ke TREATMENT PLANT cA <br /> p�TIERED PERMITTED FACILITY ❑ MOTEUNOTEL ❑ PUMPER TRUCKNARo/CHEM TOILETS <br /> 17 TATTOOIBODY PIERCING 0 POOLI$PA 0 LAND USE APPLICATION SRES <br /> 0 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the typo(S)of files from the list above by checking v <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2092464-0138 or mail to the <br /> address indicated above. <br /> p. EHD will notify the applicant if any EHD files exist An appointment for review will be confirmed <br /> approximately five bUSlnOSs 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, aA file that is actively being worked on by EHD Staff may not be immediately available for review. A nevi <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 EHO 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 /> S. "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 /> ME I-Ap <br /> .,- .�. <br /> y F)f1C 4�HO <br /> rwauxo°e ' <br /> ranee <br />