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Vd/VZ/ZVVb 11:20 hAX 4 002/002 <br />-.,W SAN JOAQUIN COUNTY <br />ENVIAOIN-MENTAL HEALTH DEPARTMENT <br />MM - 2 2006 304 E Weber Ave 3b Floor Stockton, CA 95205 Z / �� <br />ENVIROMIDNIT i -IEA R9) 468-3420 Rax: (209) 464-0136 Web- www.co.saa joaquia.caus/ehd (/Z �(� <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />L Slims BusINESSIAGENGY: kl FJ1J . <br />TENTATIVc* APPOI"ENf DATF 3(I fo lO(c Time: <br />(please allow 10 busieesa days frOM date of MP01"ation submi=D <br />© CHECK BOX TO EXpEDRE REOLI£ST - sq:ixo FEE- REQUEST PROCESSED W 0 BUSIHESS DAYS <br />DATE <br />SIGNATURE OF APPUGANT <br />1� <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />Depadmd use or+y <br />UNIT <br />❑ <br />Unit 1 <br />Unit 2 <br />Unit 3 <br />Unit 4 <br />[] <br />Unit 5 <br />W� <br />UNDERGROUND YANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT ISL. SOLID WASTE FACILITY <br />❑ FOOD FACILITY 17 SOt.ID WASTE VEHICLE <br />OTHER CLEANUP SrM (NON -LOP) l7 DOG KENNEL f9. DAIRY <br />UNDERGROUND TANK (TdONrrOR1NGJ-isEMOVAL) ❑ CHICK� <br />EN RANCH -PKG TREATMENT FLAIR <br />ffi HAZAROWS WASTE GENERATOR TEtlHOT`cL ❑ PUMPERTRUCK/YARDICHEMT0ILETS <br />E3 TIERED PERmrrTEo PACILRElMO <br />Y C3OTE7 HO M LAND USE APPLICATON SITES <br />[3TAYTOOI8ODY PIERCING ❑ OTHER (PLEASE SPECIF'r) <br />PA <br />13MEDICAL WASTE FAC1LfTY <br />1, List up to ten addresses in the space ahove. Select the type(s) of files from the list abo_va by checking <br />the appropriate box(es). At least one file type MUST be selected. Fax to (2091 464-01L8 8 or -mall 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 riles <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 END staff may not be immediately available for review. Anew <br />application may be submitted when the file is available. <br />4. Any file not returned in the same condition as released will reorganized <br />a $93.00yEHDStafj at the exoerlSe <br />deposit prior to review <br />of the applicant. Future fife reviews by the same app mayrequire <br />5. `TENTATIVE appointment dates must be confirmed with EHD staff, <br />6. Applications received after 3:oo pm wilt be processed the next business day. <br />G�NFIF Q __ I I INTIAENT �A7E': " t' ;` ; TIME : s +�i %-'. zie•`• . <br />�•^•�"1 <br />FAX <br />REVIEWED YES NO REVIEW DATE <br />