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OWNEDSAN JOAQUIN COUNTYPUBLTC HEALTH SERVICES �µ4L�GNIIAieER <br /> `� �` <br /> OCT 0 4 2000 <br /> ENVIRONMENTAL <br /> 04 EAS w eERAVENUE,HEALTH <br /> D FLOOR <br /> STOCKTON CA 95202 <br /> ENVIRONMENT HEALTH (209)468-3420 <br /> PERMIT/SERVICES PUBLIG RECORDS RELEASE APPLICATION <br /> APPLICANT . . — 13VSJKESSIAGENCY � ) In • <br /> ADDRESS 2$25 �• !"{ Y�{[ CE- <br /> PHONE Z FACSIMILE 2 � - t?tvZr! <br /> TENTATIVE'`APPOINTMENT DACE 10-11-24200 TIME <br /> (Please give 7 to 10 business Gays from date ul BP0C.00n submltlal) <br /> I <br /> CHECK BOX TO EXPEDITE REQUEST- 701=fd- EQU ST kOCES D[N3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> 4 <br /> FILE A13DRESS THUS SIDE EHD STAFF USE ONLY <br /> . <br /> PROGRAM ELEMENTS SEARCH <br /> 6 74=-4qt Avdi Q I I <br /> 74--74 <br /> C c efee. Htc� <br /> v5 h�i(L <br /> .1140 kfa <br /> arrlr?t'Lr 1111� 3=' <br /> rn Hier ;�e <br /> f a,�'s a-cr�c ,4Vt• l <br /> i <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> jiC UNDERGROUND TANK(UST)CLEANUP SITE(LOP) d HOUSING ABATEMENT 1r SOLID WASTE FACILITY <br /> JK C}THER CLEANUP SITE(NO"OP) ❑ FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> JO UNDERGROUND TANK(MONITORIMGIREMOVAL) O DOG KENNEL 0 DAIRY <br /> 1� HAZARDOUS WASTE GENERATOR O CHICKEN RANCH © PKG'TREA"f UCKJ PLANT <br /> 0 TIERED PERMITTED FACILITY O MOTELIHQTEL O PU0IPERTRUCKlYAROICHEM TOILETS <br /> © TATT001BODY PEIRCING Q PdO11SPA - ❑ LAND USE APPLICATION,SITES <br /> 0 MEDICAL WASTE FACILITY ❑ PUBLIC WATER SYSTEM . © OTHER(PLEASE SPECIFY ABOVE) <br /> List up to ten addresses in the space above. Select the types):of Files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax 9 464.0138 arm o thR <br /> address indicated above. <br /> 2. EHD will notify the applicant if any END 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 I�HD staff may not be immediately available for review. A new <br /> application may be submitted when the file 1S available. <br /> 4. Any file not returned in the same condition as released will bo reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$87.00 deposit prior to review. <br /> 5. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:04 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS ' <br /> REVIEWED YES NO REVIEW DATE <br /> i <br /> ERGO i♦ MOTM9 <br /> znn Crh T7AA axe ,��-. .�., ...,•.;.. ,..... .. _.. ,.._ _ <br />