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EMD LOG NUMBS; <br /> MPLM ,!i D!! SAN JOAQUIN COUNTY � <br /> ENVIRONMNTA L HEALTH DEPAPrMNT <br /> t; 2 I [005{ g 304 E Weber Ave 3rd floor Stockton, CA 95205 <br /> ENVIR��NI��Eid T NLR M�468-3420 Fax: (209) 464-0138 Web: www�.co.san joaquin.ca.us/ehd <br /> z 1 407 <br /> PERMIT/SERVICES PUSLZC RECORDS RELEASE APPLICATION <br /> f y� <br /> APPLICANT._ Siam NJAW BUSINESS/AGENCY- <br /> ADDRESS: OZ �7 J <br /> PHONE: eda --�Ml _ ` _ FACSiMILE: d* 10- g221 <br /> TENTATiVE"APPOINTMENT DATE: �� 5 _ Time: <br /> (Please allow 10 business days from date of aaplication submi"o <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS i }} <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> °tom' a AV MI ❑ Unit 1 <br /> ekwr✓K <br /> Unit 2 <br /> 4. Swee3 Z u.w'- eo 5 C3 <br /> • 35 . C,her>d oily s rx, �Unft 3 <br /> s. succi I tA3�a�k-tr 1ct�'•S�e1. �; ��ri7C s ' "� �i <br /> v. 1Z tNvAf rlva SNt+c*'hrr M <br /> w 9 3 Unit <br /> X00 GUrx.A-,r kw rg. c y3Yf4 <br /> •. s a ❑ Unlit 5 <br /> ENViRONMENTAL HEALTH DEPARTMENT FILES <br /> a/UNDi-RGROUND TANIC(u8T)CLEANUP SiTE(LOP) M HOUSiN 3 ABATEMENT 13 SOLID WASTe FACILITY <br /> Ort'OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY O SOLID WASTE VeHiCLE <br /> UNDERGROUND TANK(MONITORINGIRP-MOVAL) C3 DOG KENNEL O DAIRY <br /> t9 DOUS WASTE GENERATOR Q CHICKEN RANCH Q PKG TMEAfMEW PLANT <br /> 0x Rt D PERMiTTED FACiLITY C3 MOTELtHOTEL d PUMPER TRUCWYARDICHEM TOILETS <br /> O TATTOWBODYPIERCiNG O POOLISPA D LAND USE APPLICATION SITES <br /> CJ MEDICAL WASTE FACILITY CI OTHER(PLEASE SPECIFY) <br /> 7. List up to ten addresses In the space above. Select the type(s)of files from the list'aboye Py checking <br /> the appropriate box(es). At least one file type MUST be selected, Egx to(209)454.O138 or mail to the <br /> edgress lodicated 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. -4 file that is actively being worked on by EHD staff may not be immediately available for review. A neo <br /> application may be submitted when the file Is avallabie. <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$93.00 deposit prior to reviev <br /> 5, *TENTATIVE appointment date$must be confirmed with EHD staff. <br /> S. Applications received after 3:00 prn 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 /> go <br /> a <br /> �ertoo� . <br />