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T E IVuO, - q EHD LOG NUMBER <br /> GIv 'in, � SANJOAQuzNCouNTx <br /> I� ENVIRONMENTAL HEALTH DEPARTMENT <br /> NOV L 2 [0 304 E Weber Ave 3r" Floor Stockton, CA 95205 <br /> 09) 468-3420 Fax: (209) 464-0138 Web: www.co,san joaqu.in.ca us/ehd � 9 <br /> ENVIRONMENT HEALTH �vv/ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT-. 7100(�11 1Gk14kC!41 9USINESS)AGENCY: )OO <br /> ADDRESS: <br /> rr�'�,�-ylroZ�/-I.yi(2,IFYrYI aA. J IJ�1 <br /> PHONE: c2C9 3(07-3-70 k FACSIMILE;/ 2 3�r1-Dq' -I GSL Sf /� p <br /> TENTATIVE"APPOINTMENT DATE: Dec-el0 ZC0 Time: `t f-yM <br /> (Please allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST <br /> �-($93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT tv^a DATE 11hT-10] <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. S".M Elm %cAc Ave all 6+nc <br /> z. street OD GtGi r,, .4ry A G1 5'IZJG *{�✓� ❑ Unit 1 <br /> 3. 311,11 WVIOV )Il7:Vjcit [:3 Unt 2 <br /> 1 �Xv5 <br /> 9. SV,era p` CII 0 <br /> s. SV e1 -7 iia A-V R. GI SA-v( tK vt Unit 3 <br /> e. almee 4 110 ll?eiiPic AIK GI 5-WC K,474A 0\1 <br /> r. 91'.11cit Unit 4 <br /> 01* <br /> 9. $Incl city <br /> 9. stroel city ❑ Unit 5 <br /> 10. SVM G <br /> �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Cr UNI3FRGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> LSI OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> r�//UNDERGROUND TANK(MONITOR]NG/REMOVAL) 171 DOG KENNEL 0 DAIRY <br /> f9 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> [� TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOlBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY ❑ OTHER(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 /> 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 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 /> 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 [LATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> tHn<ea2�oa - <br /> denla3 <br />