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EHD LOG NUMBER <br /> WL EI ll LCL SAN JOA.QUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ^ <br /> NO V [0 304 E Weber Ave 3r"Floor Stockton, CA 95205 <br /> �09)468-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONh"ENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELF,ASE APPLICATION <br /> APPLICANT:((jj I )t1Q li' -s�✓7L'&- I_BUSINESS/AGENCY:�f�X. !l!(U/�/Y, /f 4 ✓TS�C1Id(P� <br /> ADDRESS: 102 =-7Yi.�t7` Y1A.l._ 4 (� `J <br /> PHONE:�' ,1 !-- � � FACSIMILE;I � r� ��-7 ' `ia n <br /> TENTATIVE*APPOINTMENT DATE: , )ec_ to O 5- Tlme: t An <br /> (Please allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE--REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE tlI�zI07 <br /> Deparlmant Use Only <br /> FILE ADDRESS UNIT <br /> 1. smm JAI I �(G CA—j_q ON ❑ Unit 1 <br /> 3. SVeet pd A}v,& GI 5'hOG. eF=N 5 7 rh ;y15 <br /> 3. street VI cl 1 �. [] Unit 2 OC' <br /> 7. aireel r$ e— R I F. '- <br /> s. Sweet 7 IDS 'Slh A-1v Z� ai �Uc K-tr t I' Unit 3 <br /> 6. Street IIO R(FGI'�K \u'c ca�sJ'#'[1G Nt <br /> 7. stmet CII 08001 Unit 4 <br /> a, $Imc1 CII <br /> a. Sireel ­ ❑ Unit 5 <br /> 10. Sireet G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I/UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> Il(OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 5/.UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL 13 DAIRY <br /> I9 DOUS WASTE GENERATOR 0 CHICKEN RANCH 13PKG TREATMENT PLANT <br /> TIEREb PERMITTED FACILITYP MOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOMODY PIERCING ClPOOVSpq ❑ LAND USE APPLICATION SITES <br /> ❑ M EDICAL WASTE FACILITY ❑ 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 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. -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 sante applicant may require a $93.00 deposit prior to review. <br /> 5. *TENTATIVE appointment date$ must be confirmed with EHD staff. <br /> 6. Applications received after 3:DD 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 /> eHb ��— <br /> el&p003 <br />