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L'11D LOG NUMDCIt <br /> SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> NUV 2 0 2007 304 <br /> 304 E Weber Ave 3`" Floor Stockton, CA 952056fo <br /> ! NVIRQNMENT HF/t� )468.3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca. s hd <br /> PERMIT/SERVI <br /> C <br /> E <br /> S <br /> PUBLIC Rl';CORDS RELEASE APPLICATION <br /> APPLICANT: nlYOr/ CC^"7,, Q `,{) BUSINESSIAGENCY• <br /> ADDRESS: "1C1--Z1. I S "'� V_a ��v <br /> PHONE: ate '1 f LTD� FACSIMILE:, p��� � ���`� <br /> TENTATIVE"APPOINTMENT DATE: I ?"a Time: 9 <br /> (Pleasa allow io business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST $93.00 FEES-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE I 20 O`� <br /> SIGNATURE OF APPLICANT Department Vse Only <br /> UNIT <br /> FILE ADDRESS <br /> 11 steel! 383tp N. u E ❑ Unit 1 <br /> 2. Slreel 3931 m+^'+(IeN Cl <br /> 0. stre0l 3 I !Z' N <br /> L,,O-�EEn CII 0 Unit 2 <br /> a. slreel 351(0 lJ. il'�j''e\ ul <br /> s. sveM �✓� i4lr Ad k CisUnit 3 <br /> -- \L <br /> 8, Slrecl O¢� �j1�S� UJB cn <br /> oil <br /> &. sveel <br /> 3£ ( I rj•' In cdx cnv Units <br /> 10. Slrncl <br /> iZSS E- ci <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES J <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLI <br /> ❑ FOOD FACILITY ❑ SOLID WASTE V CLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR L1 MOTELIHOTEI. ❑ PUMPER TRUCKIYAROIGHEM TOILETS <br /> TIERED PERMITTED FACILITY p FOOL/SPA 17 LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY <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. 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, <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 PATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> END 4"2-006 <br /> 10!8!x00] <br />