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EHD LOG NUMBER <br /> DA ECEEP&D `,d SAN JOAQUIN COUNTY *,j <br /> RECEN90 ENVI RONMENTAL HEALTH DEPARTMENT <br /> FEB 0 6 2004 304 E Weber Ave P Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:www.co.san-joaquin.ca-us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: i I _,BUSINESS/AGENCY: vi�'�w <br /> ADDRESS: <br /> 10 t13 4V10- <br /> PHONE: fV 3 FACSIMILE: 0�- <br /> TENTATIVE;APPOINTMENT DATE: Tirne: <br /> (pious 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 <br /> GLS 4 0A-*Uee- '( DATE d <br /> Deparbnent Use ONY <br /> FILE ADDRESS UNIT <br /> sre.c _ 0 Unit 1 <br /> z. 31Md 3 o G-r '`1 s u^' A A029 <br /> s. 6b" oto`? [c < < Unit 2 <br /> 4. stNd 7-t a `f <br /> s ;;L-1-0 2-7 Unit 3 <br /> S. sb" ;L22 li ' <br /> Ow Unit 4 <br /> s. sr ee c.{-7 617 t ccig <br /> s. areae 29 T < << CRY ❑ Unit 5 <br /> �o. awed <br /> V to G o c < <tM 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> SOUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT SOLID WASTE FACILITY <br /> CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> kTHER <br /> NDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL DAIRY <br /> WASTE GENERATOR 0 CHICKEN RANCH KG TREATMENT PLANT <br /> Ng HAZARDOUSTIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKfYARDICHEM TOILETS <br /> O TATTOOIBODY PIERCING E3 pOOUSPA 0 LAND USE APPLICATION SITES <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(2091464-0138 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. Anew <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 /> S. Applications received after 3:00 pm will be processed the next business day. <br /> ONF�R-1aD APPbiNTMENT ATE z TIME = <br /> �ATE:CONFIRMED PHONE FAX NITIAI:S <br /> ASVIEftlj =. YES NO REVIEW DATE <br /> am 48424" <br /> 818fam <br />