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I <br /> Sep 02 05 08: 34a piE # 408-1_91224 P. 1 <br /> d <br /> 'WED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> SEP - 2 2005 ENVIltONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 . <br /> ENVIRONP�ENT N �T 68-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/ehd <br /> PERMIT/SERVICES 7-f� <br /> PUBLIC RECORDS RELEASEI APPLICATION <br /> APPLICANT; V I/Y� _/'�1 BUSINESSIAGENCY: .f��S E n'l rq/l/i2p&_k L5,i S,.fryj 'O <br /> ADDRESS: I 3 D yS Aas Co M Av-e fi SQL TO Sg-_ ..CA 9 Sf aZ <br /> PHONE: -{ FACSIMILE: <br /> f TENTATIVE*APPOINTMENT DATE: Time; {/( <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 �r <br /> SIGNATURE OF APPLICANT DATE <br /> yA< Departrnerit Use Only <br /> FILE ApDRESS UNIT <br /> ,. Street C V. <br /> x. save} vot rutmm <br /> �■wL S C]. Unit 1 <br /> 3. Shaeft6m 'L ❑ Unit 2 �- <br /> 4. Street C <br /> a <br /> S. Street C{ _ <br /> 3 f t Gt CI j A)i 3 e <br /> s. s reel r <br /> 7. St-met - ch <br /> - <br /> n. sheet 5Unit 4 .. <br /> 4, %J? <br /> streM i <br /> LID. Sheet <br /> .� ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY i <br /> .4!r-DTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> -A"NDERGROUNDTANK(MONrrORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> �AZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS I <br /> 0 TATTOOIBODY PIERCING © POOLISPA ❑ 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(209)464_-0438 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. 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. f=uture 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 /> G. Applications received after 3:00 pm will be processed the next business day. <br /> y <br /> CONFIRMED APPOINTMENT DATE TIME j <br /> DATE CONFIRMED PHONE FAX INITIALS � <br /> REVIEWED YES NO REVIEW DATE <br /> CHO 43-02-00 <br /> erenoa� I <br /> - <br /> I <br />