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U3/I//21111b lb:bb 2U33b94228 NEIL ANDERSM ENVIRO I'Hut Diru <br /> EHD LOG Ni cR <br /> I IN� DD SAN JOAQUIN COUNTY <br /> L ENVIRONMENTAL HEALTH DEPARTMENT <br /> Fe.L11 1 U 2005 304 E Weber Ave Yd Floor Stockton,CA 95205 ' A <br /> (209) 4683420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca us/eh lT/J <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES^ PUBLIC RECORDS RELEASE APPLICATION _ <br /> APPLICANT: l�`�V�S"ffi�1��cv BUSINESSIAGENCY: 0- <br /> ADDRESS: —� _ ,•. I— <br /> PHONE: 0091— ��� s� t ACSIMILE:" <br /> TENTATIVE'APPOINTMENT DATE: a' <br /> (Please allow 10 business days f a plication submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use On <br /> FILE ADDRESS UNIT <br /> ^)� I, seeelc, [] Unit 1 <br /> HvJ US street1 <br /> H W t-lS. 6uee M r'1 M1vF 204 C1 Unit 2 <br /> t <br /> H�J I <A e. swa al <br /> s^Ilv uly, Un1t3 <br /> 1 e. SVeel p <br /> N/� '/. Slrcel S• ''t� e ImeUnit 4 AIIIIIIIII <br /> ❑ Unit <br /> re. Seeet el 7 <br /> l'/'t��u_J 0 ,Q;ENTAL HEALTH DEPARTMENT FILES <br /> f� UNDERGROUND JUSTI CLEANUP SITE(LOP nl0F HOUSING <br /> ABATEMENT 13 SOLID❑ SOLID WASTE FACVFHILITY <br /> E <br /> TE <br /> IX OTHER CLEANUP SITE(NON-LOP) o''qqpg <br /> 7� UNDERGROUND TANK(MONITORII �MOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> 'QL HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> t 'TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM T( <br /> Cl TATTOOIBODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1_ List up to ten addresses in the space above. Select the types)of files from the list above by chec I <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 some condition as released will be reorganized by EHD staff at the expE a <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 /> F rl/ OJ111f. <br />