Laserfiche WebLink
jE IVDA ,I,,. I_ EHD LOG NUMBER <br /> Ul]L��LSU 1 LSU SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT /1 <br /> NO V e 2 [D 304 E Weber Ave 3"' Floor Stockton, CA 95205 7 <br /> 09) 468-3420 Fax: (209) 464-01.38 Web: www.co,san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMITtSSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:(j 1 I I IQ ,�-/L�_• I BUSINESVAGENCY: B�f �dY '( ✓,7 Q fP ' <br /> ADDRESS:^,-t��2�1Z-" Y1�2t7 Ji71 y1��f �,�,ry Jn IJ <br /> PHONE: t0' ,.�p�-3-70 FACSIMILE; (2't �c I-D�"I ' LAnTENTATIVE*APPOINTMENT DATE:_ l2,� D Z1005- <br /> Time:A_ <br /> (Please allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-1$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ttI�� I07 <br /> Oapariment Use Only <br /> FILE ADDRESS UNIT <br /> 1. sim�1 51 'r,n {�G •.'C'f4_—J cal 51'OGK{v ❑ Unit 1 <br /> 2. Sunt V✓ Arw$ 01 ✓� 5 7 .n� \1� <br /> aft �t .�1E. cn�'�G i � L. lXl <br /> s. St all [� Unit 2 Q <br /> n. so-eel D CS e_ G1 v 1 - <br /> s. suets '7 LAC, PvR c1 SE VCK-krWk L Unit <br /> 6. elreel1I O 10,e i� city. S +� t3 K• ��� <br /> 7. stmer Ilk, Unit 4 <br /> a, Slmcl CII <br /> 9. Street city ❑ Unit 5 <br /> 10. SIree1 CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> R UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> Ml`OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> W UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL CJ DAIRY <br /> t9 jHAYARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY Cl MOTELtHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 0 TATrO01BODY PIERCING O POOUSpA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> 1. 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 to (209)464-0138 or mail to the <br /> W123S 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. 4 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 CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> RN<14G.02-0OC <br /> dsr4oa2 <br />