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08/31/2005 17:16 FAX 209 9480621 /4002/002 <br /> SAN JOAQUIN COUNTY <br /> rLNARONMENTAL HYKALTH DEPARTMENT <br /> 1 2005304 E Weber Ave 3"1 Floor Stockton, CA 95205 <br /> ENVIRONMENT HEA Y89) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca-us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANf: I &A BUSINESS/AGENCY: eiNr"d r <br /> ADDRESS=�}, (�(�buo`S �1 <br /> PHONE: r % i "~I �{�. �" (XJD FACSIMILE: 90 1 q0— 016091 <br /> TENTATIVE"AF,POINTMENT DATE: Tlme_ A M <br /> (Please allow 10 business days from date of app(leation submittal) <br /> CHECK BOX TO EXPEDITF-RECIUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT i2[fytf. ld 4el '� DATE <br /> Ceoartrnent Use Only <br /> FILE ADDRESS UNIT <br /> D -.as4 Llr , l e-�- G TOCK-FOAJ <br /> ❑ Unit 1 <br /> 2. 34ISC4 G <br /> a_ svca4 Cky <br /> � Unit 2 <br /> 14. Steal GtY \� <br /> s. s a Unit 3 <br /> 6. <br /> city <br /> T- svcc+ u �Unit4 <br /> - <br /> '9. s,re-A oty Unit 5 <br /> ,o• Saect err <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) Q HOUSING ABATEMENT souo WASTE FAC1l.fTY <br /> OTHER CLEANUP SITF(MON-LOP) ❑ FOOD FACILITY ❑ SOUO WASTE V>=HICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL X DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH )ILPKG TREATMEwr Pt.ANr <br /> TIERED PI=RMrTTED FACILrTY ❑ MOTEUHOTEL ❑ PUMPER TRUCKIYARD/CHEM TOIL.ErS <br /> ❑ TATTOOMODY PIERCING ❑ POOLtSPA LAND USE APPLICATION SITES <br /> Cl MEDICAL WASTE FACILrIY ❑ OTHER(PLFASE 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 bor(es). At least one file type MUST be selected. Fax to 209 46.4-0138 or mail to the <br /> address indicated above, <br /> 2_ EHb 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, 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 EHO staff, <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> 1, .4•IIN.,... � • .TIME `•.:,•vy�:; . �:�:•,. : ,•_.• • <br /> GO F RM�D..APF?OINTMINT'DATE' ::r l•; r ,r: <br /> �. •. .',.�.-.... ,.• `I •.t. .. .• �1�r ' - :•moi„.,..+•..•1'i• °.•.. •.. <br /> ,T-E-CONFIRMED _--'� - `r'PHONE FAX. ` ''7�' r:•INfT1ALS r <br /> ' '',:• . <br /> REVIEWED YES NO REVIEW DATE" ; <br /> ' cNn tn.n�.noR . <br />