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.a-tl"M312005 15:17 FA% 209 9480.621 Q002/002 <br /> �n cnv�w.,....w". <br /> U SAN JOAQU1N COUNTY <br /> ENVIRONMENTAL EIVEALTH DEPARTMENT <br /> FFR a S ?0q9 304 E Weber Ave 3"Floor Stockton,CA 95205 <br /> ENVIRONMENT HAN468-3420 Pax; (209)4640138 Web;www.cosan joagnin ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE A PPLICATYON <br /> . /* <br /> APPLICANr: F%,- St. BUSINIMIAGEHCY__ <br /> ADDRESS: aS - rv. t` _ . ,., �� q ��• <br /> PHONE: Sig OIW- !NJ FACSIMILE___8XR_ r 94 5 <br /> TENTAT[W APPowwENr DATE:_ �+ Thme: I'a <br /> (Pima*avow 10 business days horn data of applbzdan svhrnftWQ <br /> CHECK BOX TO EXPEDITE REQUEST-593.00 FM—REQUEST PROCESSED IN 3 8USKM DAYS <br /> SIGNATURE OF APPLICANT f✓? DATE _ <br /> Deoaitnarl Use duly <br /> FILE ADDRESS UNIT <br /> anm <br /> � <br /> ❑ Unit 1 <br /> Ir <br /> '#3 %,Woer " q Ail— �Unit 2 - <br /> IL ck, it <br /> 11 <br /> A.), Urn Aft 4 <br /> 9 �M <br /> ' ?1 g ❑ Unit 5 <br /> I& ma Ckf <br /> -ENVIRONMENTAL HEALTH DEPARTMENT FILES VA � <br /> UNDERORCUND TANK(VST)CLEANUP sr m(Lop) ❑ HOUSiNG ABATEMENT ■i,soup wASTB FAGIE.LTY <br /> OTHER CLEAMJP SITE(NOP(-LAP) O FOOD MCILITY ❑ SOLID WASTE VOUCLE <br /> 1* UNDERGROUND TANK 04ONITORINGAIEMOVAy ❑ DOO KENNEL W DAIRY <br /> EL HAZAMD XM WASTLE GENERATOR ❑ CMCKEN RANCH NLPKG TREATlr e"PLANT . <br /> O TIERED PrAmn Eo FACILrTY ❑ MOTELA40TEL. 13 PUMPRRTRUCK/YARDICHEIA T00_Em <br /> O TATTOOISODY PIERCING CI POOLAPA 0L LAND USh APPLICATION SITES <br /> ❑ MEDICAL WASTE FAGRdrY d OTHER(PLEASE SPECwn <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above py checking <br /> the appropriate box(es). At least one file type MUST be selected. Fag to 208 138 gr mail to the <br /> address,indicated above_ <br /> 2. EHD will notify the applicant if any EHO flies 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 ne% <br /> application may be submitted when the fife is available. ' <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expens <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to revie' <br /> 5. 'TENTATIVE appointment dates must be confirmed with EHO staff. <br /> s. Applications received after 3:00 pm wilt be processed the next business day. <br /> • sS• t tdir 'I�'t}N'f"tij.+;'• •'� r'y. :t ,s.l .y,. .r <br /> D.• .,E'?�itNTiVI�N:�'11•�#�"F.�ti�r;.. s•-•",��j r• '�',.�,;^:,►•tt`tM F: •..,s i u �:•' :�'►.1- . <br /> =Sp►Tt�� N!`1Rt ��, - "•,r.tPHONE • FAX--,' .'�= {atNfTlbl-S <br /> kEVIEYI/ED YES NO REVIEW DACE' <br />