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FROM : Ground Zero An is PHONE NO. : 209 838 9883 4 <br /> 1 Nov. 29 2005 10:19AM P1 <br /> EHO LOG NUMBER <br /> RTME SAN JOAQUIN COUNTY <br /> ��uu vv ENVIRONMENTAL HEALTH.DEPARTMENT <br /> NOV 2 q '1005 304 E Weber Ave 3'Floor Stockton,CA 95205 U <br /> (209)468-3420 Fax: (209)464-0138 Web: www,co.san joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT5ERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: fy BUSINEsSIAGENCY: <br /> ADDRESS: I7 / �j n p O <br /> 00 FACSIMIL <br /> TENTATIVE'APPOINTMENT DATE-p-(`OiYV\ ' _—Time: "O <br /> (Please allow ID bUslnass days from date of appOcation submittal) <br /> © CRECK BOXTO EXPEDITE REQUEST-593.�0(0�F(EE—REQ,UEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT S W W _ DATE 0�9 <br /> Department Use Only <br /> Fla ADDRESS UNIT <br /> I. spa ❑ Unit 1 <br /> z sa a Ck' <br /> s s ❑ Unit 2 <br /> s. ew.l Unit 3 <br /> e. saver <br /> T. saes( a Unit 4 <br /> a ease c <br /> s. ease ❑ Unit 5 <br /> a_ see <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �fyNDERGROUNU TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> J�J1THI;R CLEANUP SITE(NON-LOP) t7 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> tr,UNDERGROUND YANK(MONrrORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> IV HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH r7l PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY 0 MOTEL HOTEL Cl PUMPER TRUCK/YARDICHEM TOILETS •L _ -_ <br /> D TATTOOIBODY PIERCINGOLRPA CILANDUSEAP?LIIC�TION S IVM.7_{Ka <br /> O MEDICAL WASTE EACILITY �THER(PLEASE SPECIFY) <br /> 1. 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 /> One <br /> 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. <br /> 3. 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 /> 4. 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 /> 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Etmuoraoe <br /> aaxoa7 <br />