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11/08/20@4 14:46 2054677.118 AGE STOCKTON � PAGE 01/0 <br /> I <br /> €�[� D EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> EIYViRONMEN�'A,�.�HEALTH DEPARTMENTN Q V $ 2004 304 B Weber Ave P Floor Stockton,CA 95205 Z10 <br /> I <br /> 209]]458-3420 Fax: (209)454-0138 Web:www.co,san joagain.ca.us/ehd <br /> r:��=i�;,,)NW7-"NT H AL:fH <br /> P[:'i V MSERVICES PUB IC RECORDS RELEASE APPLICATION <br /> APPLICANT: OR <br /> USINESSIAORNI �Q C <br /> ADDRESS: L / J <br /> PHONE ^G. (Q " �L J16, FACSIMILE <br /> TENTATIVE*APPOINTmEwr DATE:_ _ — Time: r <br /> l <br /> lPI9299 allow 10 business days fr*m data of application sebMWAQ A0 <br /> u CHECK Box TO EXPEDITE REQU -; .00 FEE—REQUEST P.59E IN 3 BUSI14E;S3 DAYS - <br /> SIGNATURE OF APPLICANT DATE �I <br /> Dspartmant Use Only <br /> FILE ADDRESS1. street T <br /> U IT <br /> I. <br /> sftm G e p Unit 9 f� <br /> 7. street La E a G r ✓ <br /> 4. SheeSRua al%T 'fl .. '. jo �f31t2 I <br /> S. Sheat 11 'Vb-ne <br /> l� <br /> is. s� t <br /> 7 seeaMY <br /> a, srR+a Unit 4 <br /> a steel <br /> [ Unit 5 } <br /> 7 Q, S4be1 <br /> I <br /> ENviRONMENTAL HEALTH DEPARTMENT FILES <br /> NDERGROUKD TANK(UST)CLEANUP Sn-E(LOP) ❑ HOUSING ABATEMENT ❑ so1.ID wASYE FACILIT'r <br /> THER CLEANUP SITE(NON-Lop) GT FOOD FACILITY ❑ SOUP WASTE VEHICLE <br /> NDERGROUND TANK IMOHITORlNGiPr=MOVAL) ❑ DOG KENNEL O DAIRY <br /> AZ4RDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ FKG TREATMENT PLANT <br /> fl TIERED PERtitITTED FACILITY 0 MOTEL/HOTEL M PUMPER TRUCK(YAROMHEM TOu M ; <br /> C] TATT00113ODY PIERCING ❑ POOUBPA © LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE 3PECI <br /> 1. List up to telt 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 209 4 7 ail to the <br /> address indLcatt3dabOve. <br /> 2. END will notify the applicant if any END flies exist, An appointment for review will be confirmed <br /> approximately fere 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, 0 1 <br /> 3. A file that is actively baling worked on by END staff may not be Immediately available for review. A new <br /> application may be submitted when the file Is available, Is i <br /> 4. Any file not returned in the same condition as released will be reorganized by END 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 END staff. <br /> B, Applications received after 3:00 prey will be processed the next business day. <br /> COWFIRIVIE€l APIaOIIFTMEtfT DATE. :TlME:. <br /> DATE L GONF..iIME[?. E <br /> .„. .rte MNF-'! FA)F.'; <br /> Rll3 = YES: 1NCj;, ii/fiW-D�krE:' �..._..:. <br /> - <br /> l1ftY�tle3 - - <br /> I <br />