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,-,O 3/2005 15:17 FAX 209 9480671 IM002/002 <br /> SAN dOAQTIIIY COUNTY . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FF9 Il ? M9 304 E Weber'Ave 3c4 Floor Stockton, CA 95205 <br /> ENVIRONMENT AN 468-3420 Fax-, (209) 464-0138 Web:V1WW.co.san-joaquin.ca-uS/ehd. <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE AFFLICAT ON . <br /> APPLICANT: Na, ~•`�(�05(� BUSINPSS7AGENCY_ KI�- u� <br /> ADDRESS: �•S - V� > q o <br /> e , <br /> PHONE- FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE:_ al E16 '>1 : 12W -- <br /> (Please allow to bi iro«days from date of application submittal) <br /> r] CHECK BOX TO EXPEDITE REQUEST-$93.60 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS . <br /> SIGNATURE OF APPLICANT 1✓7qpq <br /> na an <br /> DDeoarb e t use only <br /> FILE ADDRESS UNIT <br /> \/ a Ern e p Unit 1 <br /> �nSr i sua c <br /> 1• <br /> J us'r H y. s Awl. o I" (3' en U - <br /> (4/F ITIM150 ot nYa <br /> X05 � <br /> kw S. suea a n Unit a <br /> V 11 <br /> J US c. sunv tiu a y� <br /> �f w <br /> L67 Met 4 7 <br /> { <br /> e. Se o 'rrar� <br /> �I <br /> UST I. 9Ytt( air ❑ Unit 5 <br /> te. 54ft My <br /> ,} <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES VA••' <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT Bt.SOLID WASTE FACILITY <br /> i OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE ' <br /> ®• UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ 000 KENNEL M DAIRY - <br /> 0 KAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH M-PKG TREATMENT PLANT <br /> a 13 <br /> 0 TIERED PERMrrTED FACILITY ❑ MOTELMOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> 0 TwrroOBOOY PIERCING 0 POOLISPA �. LAND USE APPLICATION SI�'E.S <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 209 464-0138 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 fora maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by£HD staff may not be immediately available for review. A ne, <br /> application may he 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. `TENTATNE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will.be processed the nextbusiness day. <br /> - <br /> •.,-RIME <br /> G'O.NF� l>PFOINTM. K ,;.` <br /> i2M D`' �N;I'A7;ATe;ir: •.,�•:�:, ..•. <br /> ?pgTE .CaNlI2l4EQ,l `i-eiPHONE FAX <br /> REVIEW' YES NO REVIEW DA7 -, '•! '... <br /> ' FMl1�M!-00B • <br />