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IV;D <br /> EHD LOG NUMBERMEN20 SAN JOAQUIN COUNTY <br /> LNVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> NOV e 2 20304 E Weber Ave 3fd Floor Stockton, CA 95205 <br /> �09) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd q <br /> ENVIRONh"ENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 71100 C 1 <br /> ' Q� 4 6USINFSS/AGENCY:�(f t, 1ftQW✓� T, ✓TS�CIQ f0� <br /> ADDRESS: oz�-Ina . <br /> I <br /> 171`<rYCY.I�_y ea\f <br /> PHONE:���(jgtq' r..JID�-3`]Ol FA�C7SSIIM,ILE: a 31D�- `(2Z Sl <br /> TENTATIVE"APPOINTMENT DATE: d--, o- (a ?co5- Time: "'l i-Sm <br /> (Please allow 10 business days from date of application submittal) <br /> ©. CHECK BOX To EXPEDITE REQUEST-$93.00 FEE-REQU <br /> EST <br /> PROCESSED IN 3 BUSINESS DAYS / <br /> SIGNATURE OF APPLICANT ��a �� DATE tl/Z'r- <br /> Deparlment Use Only <br /> FILE ADDRESS UNIT <br /> 1. slmet 51 c ',c''AvQ,. _-- Gt Sim ❑ Unit 1 <br /> 2. Steel�L.i W -IKIr"Q aty Jy Vc 'TT.H �L�5�) frl `,�1 <br /> ]. seeel �a lF(� - �G t hVC GI r�r✓ s7 1T= C3 Unit 2 e�, <br /> 1. Blreet5(006qcr$ 1'Z GI% ly--6m 1 <br /> s. seed 7I yg ePrin- Ayv1G at SyC-_l�kc�t 1L,- Unit3 <br /> %,G IT <br /> 6. stmel i 1 c PikGI� \�'�' Y� t"�cam• ��\� <br /> 7. 81reel CII Unit 4 <br /> B, slmet city - <br /> g. street — ❑ Unit 5 <br /> ID. 61me1 G <br /> �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Ca UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> M(OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 0//.UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 17 DAIRY <br /> !S AZAEiDOUS WASTE GENERATOR 0 CHICKEN RANCH 13PKG TREATMENT PLANT <br /> CI TIERED PERMITTED FACILITY P MOTEL/HOTEL 0 PUMPER TRUCKlYARoICHEM TOILETS <br /> ❑ TATToo(BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addressesin 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 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 maybe submitted when the file is available. <br /> 4. Anyfile 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 CONFIRM5D PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ENb 4442-0N - <br /> efte2tlG2 <br />