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V3/uZ/ZVuli 17 :20 YRX 1M0021002 <br /> SAN JoAQuut COUN'T'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MA`( - `la 2006 304 E Weber Ave 3nl Floor Stockton, CA 45205 �� /1 f'�(� <br /> ENVIRONMENT I IEARR9) `66"3420 Pax: (209) 4640139 Web: WWW.co-$an joaquia ea_us/ehd ✓S _ `/ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_ PCA-r.u�� n.y __BusimESSIAGEKY: <br /> ADDRESS: 2J) ? F M I' LL.,lj Q p IV <br /> PHONE 2-09 '�yi FACSIMILE ('0,7 T'E "' `` -CXP - <br /> TENTATIVE'APPOINTMENTDAT-w 3/Ito /o i -Time: <br /> (Plea-"allow 10 bush days from date of application aubmittaq <br /> © CHECK BOX TO EXpSD(TE REQUEST.$93.00 FEE—REQUEST PROCESSED L4,3 BUSINESS DAYS <br /> SIGNATURE OE APPLICANT DATE <br /> Cleparktient Ube only <br /> UNIT <br /> FILE ADDREss <br /> . t <br /> Unit <br /> i t <br /> > p� Unit 2 <br /> s su.a Unit 3 <br /> Unit 4 <br /> r. svom <br /> Cl Units <br /> 'i skx <br /> to s� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP Sire(LOP) C' HOUSING ABATEMENT at,SOLID WASTE FA LCLF <br /> OTHER CLEANUP SITE(NON-LOP) 13Foop FACILITY ❑ SOCIO WASTE Y£HICI.E <br /> M UNDERGROUND TANK p4o"i-MRINGIREMOYAL) ❑ DOG KENNEL t-9-DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ilL pKG TREATNEKT PLAN <br /> ❑ HAZAR OUS W TEO FACiI.IR ❑ MOTEL/HOTEL ❑ PUMPERTRUCK/YARD/CHEM TOILETS <br /> ❑ TIERFn ERM PIERCING ❑ POOLISPA a LAND IMF;APPLICATOR SfTES <br /> ❑ MEDICALWASTE PIERCING <br /> ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list "boyo by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the <br /> address indicated above. <br /> 2. EHD will notify the applicant if any EHO files exist- An appointment for review will be confirmed <br /> approximately rive 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 reorganizeduire a$93,00HD staff <br /> deposit prior to review. <br /> of the applicant Future file reviews by the same applicant may req <br /> S. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> Applications received after 3:00 pm wilt be processed the next'husiness day. <br /> �Gi�NFd,F�lvi� ROINTh1ENT'ISLl7E': `�=nn;`5�.: ,; . -,TIME .�:.�-;•.Sr£irii .' — , . <br /> .,:' ,.: <br /> r. s:;hlN IALS ' tT <br /> _ ;',.PHONE . FAX FF.. <br /> [SQTE. gNFiR ED: <br /> REVI.EVlED YES NO REVIEW DATE' �� <br />