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07/29/2005 10:25 FAX 209 948062 (21002 <br /> {{��((�� q nI� � nI- Gnu.v.,rvnlv`tY <br /> °WLR O V ISD SAN JOAQU[N COUNTY <br /> ENYLRONNJENTAL HEALTH DEPAPTNIENT <br /> JUL 2 9 2005 304 E Weber Ave 31u Floor Stockton, CA 95205 209)) 468-3420 Fax: (209) 464-0138 Web: %vW.co.sanjoaquin.c*-uS1ehd ) OZ <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES f_p(JBLIC RI CORDS RELEASE <br /> p�AppLIC CATION <br /> APPLICANT- /L1.0 C' WS r, DUSINESSIAGENCY; (fF1 rt at <br /> ADDRESS' r` <br /> PHONE: ,j\ `'(S FACSIMILE: Z <br /> TENTATIVE'APPOINTMENT DATE: ��y g 71Kp.� Time: <br /> (Please allow 10 business days from date of APPlicadun submittal) <br /> L-I CHECK BOX TO EXPEDITE REQUEST-597.00 FEE-REQUE5T PROCESSED IN 3 BUSINESS DAYS <br /> DATE L'S ZF�OS <br /> SIGNATURE OF APPLICANT entuse D W <br /> UNIT <br /> FILE ADDRESS <br /> f G s ❑ Unit 1 <br /> IFS <br /> 0 <br /> F GUn{tZ <br /> gsTHIa sate <br /> 3' p. k �Unit3 <br /> 'A,ST 140) 5.e. <br /> H saes O <br /> .I Unit 4 <br /> W T. SAM <br /> le <br /> LIf11t 5 <br /> f. S <br /> G U <br /> a 2 <br /> 1a. Saea - La. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FIdow <br /> UP SITE{LOP) HOUSING ABATEMENT <br /> eLsOUO WASTE FACILITY O <br /> ,� {{ <br /> UNDERGR0 OUNo'TANK(UST)CLEANSOUD WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-Lop) DOG FACILITY E3g DAIRY <br /> M UNDERGROUND TANK(MONrrORINGIREM OVAL) [3DOG KENNEL �pKG TREATMENT PLANT <br /> g710TpOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PUMPER TRUCKIYAROICHEM TOILETS <br /> LI TIERED PERMITTEO FACILITY ❑ MOTELMOTEL IS LAND USE APPUCAnoH SITES <br /> C3TATTOOMOOY PIERCING ❑ a-niER(P <br /> ❑ MEDICAL WASTE FACILITY d OTHER(PLEASE SPECIE'() <br /> nJ <br /> 1. List up to ten addresses in the space above. Select the types) Of Fax les from the list 139aboCC <br /> it to the <br /> _ the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0139 or mail to the <br /> addresaindicated above. <br /> 2- EHD will notify the applicant if any EHD files exist- An appointment for review will be conFr Th <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 live 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. ne <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- •TENTATNE appointment dates must be confirmed with EHD staff. <br /> 8 Applications received after 3:00 pm wilt be processed the next business day. <br /> TIME w <§;.: a•::'+ :_4,5> <br /> ;C�NF,(RMEH. <br /> K-17' <br /> ENT7. ase*�+r. ::tlr'= -r••' <br /> r•_.r^''li PHONE ,:x:,;irINTfIALS ' <br /> .: FAX _ <br /> ;D ATE.C,QNFI}2ME� <br /> REVIEWED YES NO REVIEW DATE <br />