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U3/1//PUUb 1b:b8 2U93b94228 NEIL ANDERSON ENVIRO PAUL U11U <br /> 0 0 EHD LOG N: ER <br /> SAN JOAQU N COUNTY <br /> E+1,11RONMENTAL HEALTH DEPARTMENT /0 <br /> '62005 304 E Weber Ave 3`d Floor Stockton, CA 95205 p <br /> (209) 468-3420 bW�vw.co.san-joaquinxa.us/ehd <br /> (209)464-0138 Web: ww.co.sanjoaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION. _ <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS:nn^qnl SYLLS5,:Yi <br /> PHONE: -2aC) t FAGSIMILE:'_� <br /> TENTATIVE"APPOINTMENT DATE: r r •. .- e: <br /> (Please allow 10 business days f a plication submittal) <br /> 70 CHECK BOX TO EXPEDITE REQUEST-^$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 19 s)9 A LLt DATE <br /> Department Use On <br /> FILE ADDRESS <br /> UNIT <br /> l 1�c, m av Y1��A rn� ] Unit 1 <br /> NvJ t US <br /> z. streettA[4i <br /> H w r us ;t$tree E NQ 01 tLv F 204 ❑ Unit 2 2') <br /> Hw I U,S7 4. Siam r cit J <br /> r <br /> S. SIm..1 �,4� L 11 uty_ rUnit 3 <br /> J/ 3 <br /> /). e. SveetG G <br /> \. V1/�� '/ S.Mtt �I-a S . .0 Unit 4 <br /> 1 <br /> R,➢1 B, $Isar v t��- Gi <br /> �t t.ts s. street Q Unit 5 <br /> M Street G <br /> ((�nM�� I ENTAL HEALTH DEPARTMENT FILES <br /> $4 UNDERGROUND N (UST)CLEANUP SITE(LOP) Ca'HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 1C OTHER CLEANUP SITE(NON-LOP) p�� FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> �. UNDERGROUND TANK(MONITORIt Rm� ) ❑ DOG KENNEL Cl DAIRY <br /> qL MAZARbOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> > TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILE <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses In the space above. Select the type($)of files from the list above by chec ) <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to t <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 fi <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 v <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 END staff at the expf <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to re, Y. <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 /> can aaso�nr. -- <br />