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Apr-4uu4 lu:aiam Prom-r:oraan & reas �. T-819 P.002/003 F-333 <br /> *$ 1 EHQ LOG NUMBER <br /> SAN JOAQUIN COUNTY - <br /> :, J ENMONMEENTAL HRALM DEPARTMENT <br /> RPR 3 0 20n l304 E Weber Ave 3`d Floor Stockton,CA 95205. <br /> t169)468-3420 Fax: (209)464-0138 Web:www.co_satn joaquin.ca.us/ehd <br /> NMR <br /> ONMENT HEALTH <br /> PERM S ]PUBLIC RECORDS RELEASE APPLICATION <br /> 11 <br /> APPLICANT: �'Ah '5"a1te-r 13USINES5IAGENCY: rOrdOn _KSS „LLP <br /> ADDRESS: 101 lr.� �7fgaaWdV,..„1 Su�tQ. 1400 San IDI fto <br /> PHONE: 10. W3' FACSIMILE: 7114 <br /> F I <br /> TENTATIVE!APPOINTMENT DATE:(C_A� <br /> (Please allow 10 busin985 dayy$fMM date of applit ation submittal} <br /> ❑ CHECK BOX TO E XP901TE REQUEST-S83.00 FEE-REQUEST PROCESSED INS SUSIN£SS DAYS <br /> SIGNATURE OF APPLICANT. DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I. sem, t 3 5 h w Oa o1 <br /> z. sweet S 11 Unit 1 <br /> s. saes Unit 3 d h� <br /> s, street CRY {� <br /> 7. Swm <br /> 8. Sweet �; nit 4 <br /> g, sttee: ❑ Uni <br /> 90. 5vaet - <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SrrE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE FACELrrY <br /> OTHER CLEANUP SITE(NON-LOP} Q FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMQVAL) G DOG KENNEL p DAIRY <br /> .'HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> ,TIERED PERMITTED FACILITY ❑ MOTELIHOTEL O PUMPER TRUCKIYARD/CHEM TOILETS <br /> I3 TATTOWBODY PIERCING ❑ POOLI'SPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY Q 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 selectod. 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 fbr review. A new <br /> application may be submittedwhen 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. Futt re 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 /> 5. Applications received after 3:00 pm will be processed the nextlbusiness day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EKD 4&n-DM <br /> a�o� <br />