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114/.:U/ZUU4 11:04 kAA ZUe U44UUZ1 wjuuZ <br /> S 10� <br /> LOG NUMBEii <br /> o rea c I� 'N JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br /> JUN 3 0 2004 ENVIRONMENTAL HEALTH DIVISION <br /> j 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 ]vt <br /> ENVIRONN�Ei�Jl ritALTH (209)4GO-3420 <br /> PERMIT/SERVICENBLIC RECORDS RELEASE APPLICATION <br /> I <br /> A PucANT E-�C-J (� J ` BUSINESSIAGENCY 1f illI�"� Y`-^"-'•� <br /> ADDRESS <br /> PHONE `�'l'I`D ' ��kti FACSIMILE R 4T�O6 Z. <br /> TENTATIVE'APPOINTMENT DATE l b�y H TIME ( � <br /> (Please give 7 to 10 business days from date of application submlctai) <br /> CHECK BOX TO EXPEDITE REQUEST-;07.00 F —REQVEST OCESSED IN 7 BUSINESS DAYS <br /> 51GNATURE OF APPLICANT DATE 6 a <br /> FILEADDRESS . SIDE END STAFF E ONLY <br /> w p MEN EARCH <br /> l <br /> V< I , tl r t ll • - <br /> NO \�7r-tv0 W - vALf IC Pt+ Il <br /> pr l7U' Ya l l 4. .1 <br /> \ (0- <br /> la ll « `a4 <br /> I <br /> I <br /> I <br /> -7 DP,- I V4 2 <br /> ENVIRONMENTAL HEALTH DMSION FILES 7� q).�ti <br /> M SOLID WASTE FACILITY 001LETS d UNDERGROUND SITE(NON LCLEANUP) . SITE(LOP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHICLEIg OTHER CLEANUPSITE(NON4.OP) D DOG FACILITY 13 DAIRY rp UNDERGROUND TANK,(MONITORINGIREMOVAL) D DOG KENNEL W PKG TREATMENT PLANT <br /> fHAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH .O PUMPERTRUCKIYARDIC . <br /> a TIERED PERMITTED FACILITY ❑ MgTElJPATEL' (a LAND USEAPPLICATIONSITE5 <br /> O TATTOO/BODY PEIRCING <br /> o MEDICAL WASTE FACILITY pPUBLIC WATER SYSTEM p OTHER(PLEASE SPECIFY ABOVE) <br /> �1( List up to ten addresses In the space above. Select the type($)of files from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax o 209 4 38 o Mmail to he <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 Y an ten(10) days ointme ifter s shouldpbe Scheduled lication. The les <br /> will be held for a maximum of five business da s for review. App <br /> accordingly. <br /> 3'. A file that is actively being worked on by EHD staff-may not be immediately available for review. A rev <br /> application may be submitted when the file is available. at the <br /> 4r Any file not returned In the same condition as released <br /> Will <br /> May requirera$87.00 deposEHD it prior torr <br /> ensE <br /> of the applicant. Future file reviews by thb same app Y <br /> '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 /> INITIALS <br /> DATE CONFIRMED PHONE FAX <br /> REVIEWED YES NO REVIEW DATE <br />