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48-6688 P. 1 <br /> ,t 29 04 09: 58a Environmental Group 91Elio LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUN'T'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3rd Floor Stockton,CAo95?�ca.us/ehd Zo(209)468-3420 Fax: (209)464-0118-Web: ��`•CO-S j 4 <br /> Jj1 PUBLIC RECORDS RELEASE APPLICATION <br /> BUSINESSIAGENCY: <br /> APPLICANT: ( Q C 17 S <br /> ADDRESS: r.( , <br /> FACSIMILE: �y <br /> PHONE: y 6 <br /> _ t I .y I p tS Time: 00 O <br /> VE*APPOINTMENT DATE: <br /> lication submi BW-V <br /> (Please allow 10 business days from date of app / <br /> " U TPROCESSEDIN36USINESSD <br /> ECK BOX TO EXPEDITF REQUEST•E97.ao F�- DATE <br /> !l_1 <br /> SIGNATURE OF APPLICANT Department use Only <br /> UNIT <br /> FILE ADDRESS ( <br /> A G �k ❑ Unit 1 <br /> t StteN <br /> 2. strw IN. .k Unit 2 d1 <br /> J <br /> C e� <br /> �, Seeel OS 1 <br /> ON <br /> Unit 3 \\ <br /> 5. S1rt%4 NA G •, <br /> 6 Suet u Unit 4 <br /> L Std <br /> ;S c" — ❑ Unit e. Sveet G <br /> 9. SUeet MAj <br /> Ci <br /> 5 2 � i <br /> 5 � }tZ � µ' ENVIRONMENTAL HEALTH DEPARTMENT FILE <br /> EN <br /> ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> 19 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID W TE VEHICLE <br /> X1 OTHER CLEANUP SITE(NON-LOP) E3 pOG KENNEL ❑ DAI <br /> In UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH ❑ ENT PLANT <br /> 0 HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL P fi CK/YARDICHEM TOILETS <br /> F TIERED PERMITTED FACILITY ❑ pOOUSPA bSE APPLICATION SITES — <br /> ❑ TATTOOtSODY PIERCING Cl OTHER(PLEASE SF�1F,j'6) <br /> ❑ MEDICAL WASTE FACILITY !!! <br /> s of files from the list above by checking <br /> 1, List up to ten addresses in the space above. Select the p ) <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. ointment for review will be confirmed <br /> 2. EHD will notify the applicant if any EHD files exist. to ao <br /> but no later than ten (i0) days after receipt of application. <br /> approximately five business days The files <br /> business days for review. Appointments should be scheduled <br /> will be held fora maximum of five <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. Anew <br /> application may be submitted when the file is available. at the expense <br /> condi4. Any file not returned in the same <br /> Future file rev ews by the ion as released )the same applicant may require a$93.00 deposbe reorg3nized by EHDf priory to review, <br /> of the app <br /> licant.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 /> TIME <br /> EREVIEWED <br /> MED APPOINTMENT DATE INITIALS <br /> NFIRMED <br /> PHONE FAX <br /> - <br /> YES NO REVIEW DATE <br /> EHD.6-02-006 <br /> .162003 <br />