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1/22R/E220E04 14:34 FAX <br /> 209 9481 (21002/002 <br /> ` I! �J SAN dOAQUIIY COUNTY <br /> X e V y u <br /> EN MONNxENTAL MALTH DEPARTMENT V _ OO <br /> NOV 2 2 200(4 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> EidViRONPJIENT Ni6n?4)146&-3420 Fax: (209) 464-0139 Web:www.ce.sanjoaquin.ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPn/LICATION <br /> APPLICANT. I-Ye✓ $:reSlt$ BUSINESWAGENCY: IGI`✓IfU�C�' <br /> ADDRESS: 226LT r Il(Xr}(e, s44'eg4 90441,6 r GuI QraDS- <br /> PHONE:_m% -X•yLy FACSIMILE: N-t`$ OfO iL1. <br /> TENTATIVE*APPo1NwENT DATE: IR13 Tlmt: la!wD <br /> 11----II (Please dhow 10 business days from date of application submiWQ <br /> 6--I CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 2_ _s DATE <br /> I7�epartrrlenI Use Only <br /> ADDRESS UNIT <br /> +. s17 T.10 4di=1 59,477.-A0 aty 5roe orJI Unit 1 � <br /> z. 3a s } ❑ ^ <br /> a. sone '77401 X. 0 N peA5 <br /> .. sUnit 2 <br /> ueel 99 'O-e. <br /> s. such 3 LO •Ter Ro 04Y _ Unit 3 <br /> C \ <br /> e. soca r 'I[_o '1 5 0 C-1T. suedLI t4coy4e.0, 13.0 CAY 0 Unit <br /> e. seed <br /> 4400 fA grll 4 lu a STooxio#a <br /> 0. sued d ❑ Unit 5 <br /> 10. sw« CRY <br /> }� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND YANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 6t.SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOp) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> BP UNDERGROUND TANK(MONTTORINCIREMOYAL) ❑ DOG KENNEL 19.DAIRY <br /> itl HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 8.PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ FOOLfSPA 03 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY Cl OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list aboye 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 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 ne' <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 eXpens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm wilt be processed the next business day. <br /> %,CONK( MF.D.APPOINT)vt <br /> IM <br /> • .,�... ENT"DATE it �c'r."":�•- - <br /> IF ::: • an. ..: : . r.. . <br /> '•'AQl E GONF. MPHONE : FAX LLS <br /> .REVIEWED <br /> PREVIEWED YES NO REVIEW DATE' ' <br /> • ENO Ifi-02-0ai <br />