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Au•g-26-03 02 : 22P P _ 0. <br /> �d�7 •E I ) ,�� ILS EHD LOG NUMBER <br /> !!11 SAN JOAQUlN COUNTY <br /> AUG 2 6 2003 ENVIRONMF,NTAL HEALTH DEPARTMENT <br /> 304 E Webcr Ave 3"I Floor Stockton, CA 95205 <br /> ENVIRONMENI(2fflAL -3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/chd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: �4 ��1 V\ / �� y 1 BUSINESS/AGENCY: ` \ r �Z ✓l } s n 1 <br /> ADDRESS: Z(11 .5 JW P ct q A� P n I � t �/ <br /> PHONE:j`� J )I 210 FACSIMILE; <br /> TENTATIVE*APPOINTMENT DATE: r! 0-3 TIm.: L% <br /> (Please allow 10 business days from date Of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-S93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE O <br /> Department Use Only <br /> FILE ADDRESS UNI W <br /> i. e61 K"35 rh l AV -C cry T'( 1A c_ I <br /> 7. 5heal $ `j 4-1, 5-(' G, IY' t_ El Unit 1 <br /> rryT"✓ ❑ Unit 2 <br /> 4. tilnwl <br /> 2 f n+Y v _1� C. Ty, <br /> S. q1,4.1 'L /.F r it ti l A V e Gfty fUnit4 <br /> it 3 <br /> 6. SVoa `1 �f `l C 1, ✓L{ C `� � G 1 L— <br /> �. Sri, 12 S W. `1 k Cit L <br /> B. 97061 01 <br /> J. SI— von--, Uy ❑ Unit 5 <br /> 10. Street 4 — Cd <br /> .I ez <br /> AL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST),..L.., CLOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY .� <br /> OTHER CLEANUP SITE(NON-LOP) 13 FOOD FACILrrY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL 17 DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELIHOTEL Q PUMPER TRUCK/YARDICHEM TOILETS <br /> OTATTOO/BODY PIERCING ❑ POOUSPA 13LAND USE APPLICATION SITES <br /> X 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 EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no later than ten (10)days offer 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 EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE - TIME <br /> DATE.CDNFIRMEDPNQNE FAX INIT <br /> REVIEWED YES •-NO.• _ -REVIEW DATE . <br /> EHD 4a-0Z-000 <br /> 61617003 <br />