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tr1D LOG NUMDEII <br /> ( � © SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NUV 2 0 2007 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> ENVIRONMENT HFA6.7ffl��gg)468-3420 Fax: (209) 464-0138 Web.VAVW.co.saui joaquin,ca. s ltd <br /> 2 <br /> PERMIT/SERVICES <br /> , PUBLIC!RECORDS <br /> ECORDS IRELEASE <br /> ELEASE <br /> APPLICATION PPLICATION ` "{ <br /> �oc bA-C <br /> APPLICANT: D—OL BUSINESSIAGENCY: A4I ce A, )A <br /> AA <br /> 0 2 <br /> ADDRESS: ,Ja4 -3 L01 -2-1 3tCf3 FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: 1t2410!±.---rime: - <br /> - <br /> 1, <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST--$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT ' F DATE I Zf7 0 <br /> Department Use Only <br /> FILE AD RESS UNIT <br /> so-eel 3831a N. t� �' 0119 ST ❑ Unit 1 <br /> 2. 91reet 2393 I <br /> 3 •1 <br /> J. 9lreal ^ I�-7' ry . V,-) CII 0 Un.it 2 <br /> E. sheet +�I U f'j# 4A ) 1 4�\ GI a A t <br /> s. strca 333 N, qA k' cl Unit 3 \'li <br /> K. slrml ')1� N ,1,.5AAA 1 GI <br /> 7. Street % 3-2- r `�1, ---+G11 <br /> 0. slmal 3�'L 2w17Mtclt <br /> s. sue<I 3S' _nI V-rI tl: eI <br /> 10. slrn-nt J J G• cl f —� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT M SOLI k31T <br /> 7�11 OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILITY ❑ SOLID WASTE V CLE <br /> �Q UNDERGROUND TANK(MONFFORING/REMOVAL) © DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING M POOUSPA D LAND USE APPLICATION 5rrES <br /> 0 MEDICAL WASTE FACILITY 0 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(2 09)464-0138 or mail to the <br /> address indicalftEL 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 ba 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 DATE TIME _ <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW PATE <br /> ewo�aoanos <br /> 618fi00A - <br />