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dJ/I//2bdb Ib:bU Yb`J3b94228 - NEIL ANUENSUN ENVINU rmv� u+"' <br /> 0 a EHO LOG NL 2R <br /> Ul1��D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL Weber Ave HEALTH DE, CA MENT <br /> 95205 <br /> Ft'::11;t L U 2005 304 b Weber Ave Yd Floor Stockton, CA 95205 ' A <br /> (209)465-34201 x: (209) 464-0138 Web: vwvw.co.san joaquin.cams/ehd lT/J <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION y�r <br /> APPLICANT: CS S �SJ.�C.-Y BUSINESSIAAG�ENCY: NQ �QV�LT1/ -. <br /> ADDRESS: <br /> PHONE: _ilo t FACSIMILE:_� 3 �' G <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submlttal) a <br /> CHECK BOX iD ExPEDtiE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYSjFN <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use On <br /> FILE ADDRESS UNIT <br /> 1. rim'A Lytl1 J/L� Unit 1 <br /> z, street <br /> 3, Strcel �k Li' /3.53 i3, Unit 2 <br /> n ' V 1 ,. "�� Cil a /Al (.... �../ <br /> s. Strcril q 'm.e_�t-- tin ulr, �1F� i,:, Unit3�Ao <br /> e. street - `_ cl ' <br /> ]. street S . a �' t t op <br /> street <br /> R. street <br /> —quy-k �l l\( rri ��` i C D ' t'4 [] UnitS <br /> to. Sheet Ci <br /> ty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 7K UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> IX OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHIct F <br /> -9. UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> YL HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> *TIERED PERMITTED FACILITY ❑ MOTEVHOTEL ❑ PUMPER TRVCK/YARDICHEM TOILI <br /> ❑ TA7700160DY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL 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 checl ) <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to t <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 Ili <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 v <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 ezpi z <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to ret V. <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 /> FMfI AM9JI11/ <br />