Laserfiche WebLink
06/22/2004 11:59 30376?0089 TECHLAW INC - PAGE 02/0 <br /> EHD LOG NUMBER <br /> DAT,ERrIVE�� '; SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> JUN 2 2 2004 304 E Weber Ave 3 T Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web: www.co.,-,an-jQaquin.ca.us/ehd <br /> ENVIRONNIIENT hLA❑H <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASEAPPLICATION <br /> -T <br /> APPLICANT: ,' BUSINESSIAGENCY: 1 e <br /> ADDRESS: <br /> PHONE: <br /> FACSIMILE' 252 <br /> TENTATIVE"APPOINTMENT PATEN <br /> (pleas@ allow 10 be@in@sa days Tran date at application 9ubmitlel) <br /> 12 CHECK BOX TO EXPEDITE REQUEST.$9100 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE _D �Z2 (7LI O <br /> SIGNATURE OF APPLICANT I .��lld�ls'-y�� �`—r— <br /> DeparlmeMUse Only <br /> FILE ADDRESS UNIT <br /> ❑ Unit 1 <br /> : � X535 5 . Li cn <br /> a so-eet SD Si �'• `� Unit2 <br /> a. s+ <br /> s. srex �(e S• L'n D / Unit <br /> s. sweat D 5. C <br /> 91nrt 3 S. LI ¢, cn ✓ Unit4 <br /> a eaam � <br /> oell <br /> Seca D u ✓ V` (� <br /> ,,. sireac � IUr <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 11``'' ,2 ZOOS <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) C3 HOUSING ABATEMENT SOLID WASTE FACILI'T4 \- <br /> J$OTHER CLEANUP SITE(NON-LOP) 171 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(mowroRINEREMOVAL) O POG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR El CHICXEN RANCH 0 PKG TREATMENT PLANT <br /> EI TIERED PERMITTED FACILITY O MOTELIHOTEL PUMPER TRUCIUYARDlCHEM TOILETS <br /> 171 TATTOOBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> O MEDICAL WASTE FACILITY O 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(2091484-0138 or mail o 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 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. expense <br /> 4. An file not returned In the same condition as released will be reorganized by EHD staff at the exp <br /> of the applicant Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> n. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATECONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHo.ea:aoe <br /> AR/}AO] <br />