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FROM : Ground Zero Analysis PHONE NO. : 209 838 9883 Nov. 29 2005 10:19AM P2 <br /> EHD LOG NUMBER <br /> �(�DATE (R�ECEIVED(� SAN JOAQUIN COUNTY <br /> RD E `V� E L 1 E L) ENvxRONMENTAL HEALTH DEPART�I 'NT <br /> 304 F Weber Ave 3rd Floor Stockton, CA 95205 I <br /> NOV 2 o i005 (209)468-3420 Fax: (209)464-0138 Web: www.co-san-joaquW.ca_us/ehd 03 <br /> (X/ <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMI <br /> APPLICANT: BUSINESS/AGENCY: ^ <br /> ADDRESS: )\ rQ, p <br /> PHONE:I �C� ) �� /Ua� FACSIMILE:��1li� <br /> TENTATNE'APPOINTMENTDATE .04".r ) Tlme: 7Is " <br /> (Plawe allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST.$93_00 FEE-R(EQ�UE�ST,PRROCESSEDD IN 3 BUSINESS DAYS 1 <br /> SIGNATURE OF APPLICANT ._c �^� - �r DATE / OJ <br /> DeparlmarR Use Only <br /> FILE ADDRESS UNIT <br /> rn 3�� <br /> 5a'� Elunit, <br /> z sues, J n <br /> a. sre« ° ❑ Unit2 <br /> t. Sbeel r" <br /> s se<x �nit3 <br /> Unit 4 <br /> d suex <br /> e. s,,,, c ❑ Unit 5 <br /> ro.': weer <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> t�NDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> SC OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY EI SOLID WASTE VEHICLE <br /> • UNDERGROUNDTANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> 0 HAZARDOUS,WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> O TIERED PERIdfTTED.FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATCQOIHODY PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFIC <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)4ti4-0138 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 END 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 /> 5. Applications recelved 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 /> eno�sueaos <br /> uwzaw <br />