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vv• vvi vy a a.a iv lv 1'L1A MVV /VAJ - <br /> __ ni.canrcr..untt <br /> — — 7 <br /> EHD LOG NUMBER <br /> EDD uu <br /> SAN JOAQu'N COUN Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR 0 5 2404 '304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> (209)468-3420 Fay: (209)464-0138 Webr vrww.co.san joaquhLca•uslehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: f-� 4 �BUSINE391AGENCY: <br /> ADDRESS: <br /> ff 1 1 R tc�13cp <br /> PHONE: l�ILP / � ��D L_ FACSIMILE: 7v <br /> j TENTATIVE"APPOINTMENT DATE, � ,�, rte: ' <br /> (Please allow 10 business ays hom date Kapplea a1-6 <br /> in Wi) <br /> CHECK SOX TO EXPEDITE REQUESTf$93.00 FEE-R EST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE � �• <br /> Department Use ity <br /> UN <br /> FILE ADDRESS , <br /> Unit 1 <br /> 2. Strew! <br /> 3. shoe a Unit 2 <br /> Lai <br /> 4. SO" Unit 3 <br /> 5. Streel <br /> 6. Str Z <br /> Unit a <br /> �. Street <br /> a <br /> s. swot ❑ Unit 5 <br /> e. s� <br /> to. Sheat <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT j�SOLID WASTE FACILITY <br /> C3 FOOD FACILITY SOLID WASTE VEHICLE <br /> THER CLEANUP SITE(NON-.OP) ❑ .DOG KENNEL !O DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RANCH - G TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR E3MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS, <br /> ❑ TIERED PERMITTED FACILITYp POOi15PA �-LAND USE APPLICATION SITES <br /> ❑ TATrOO1BO0Y PIERCING ❑ OTHER(PLEASE SPF-CIFY) <br /> ❑ MEDICAL WASTE FACILITY checking <br /> 1• List up to ten addresses In the space above. Seiect the type($)of files from the list above by <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0138 or mai$to he <br /> address Indicated ab ve. EHD files exist. An appointment for review will be confirmed <br /> 2. EHD will notify the applicant if yreceiptapplication. The files <br /> approximately five business days but no later than forreview. Appointmentsays after shoulbe scheduled <br /> will be held for a maximum of five business day . <br /> accordingly by EHD staff may not be immediately available for review..A nevi <br /> 3• A file that is actively being Workedon <br /> application may be submitted when the file Is available. at the <br /> 4, Any file not returned in the same condition as releasedcant mareorY q uire$93.80 depoani2ed by END sts prior to expensc <br /> of the applicant. Future file reviews by the same app'li <br /> 6• *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6• Applleations received after 3:00'pm will be processed the next business day. <br /> TIME <br /> CONFIRMED APPOINTMENT DATE IHj�gL <br /> PHONE FAX <br /> DATE CONFIRMED REVIEW DATE <br /> F2EViEWED _ YES NO <br /> cyto 4"2-006 <br /> �Y <br />