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btt'-�`J-�bb4 1 b *- 28 y 21 x+1977 " t �.:' . r � 916 921 1977 H. 01/01 <br />tangy c rtc�,civcu SAN OAQUTN COUNTY !.! <br />r P'J ENVIRONMENTAL HEALTH DEPARTMENT 10% goo <br />SEP 2 9 20 304 E Weber Ave 3d Floor Stockton, CA 95205 <br />209) 468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehdOW 45? q. <br />cNVi�i ,it;Ll H PUBLIC "CORDS RELEASE APPLICATION <br />rs' r � <br />CR'! , �ERy'�r� <br />APPLICANT: i c e.a or �b Se��,� BUSINESS/AGENCY: n".) <br />ADDRESS: <br />PHONE Ck it. — Ki - i3g3`l FACSIMILE: <br />Qltfl-92'�-91oz <br />TENTATIVE* APPOINTMENT DATE_ Time: p9 0a <br />(Please allow 10 businan days from data of application submittal) <br />❑ CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT <br />�. stmt r1'S�'S <br />d L <br />s. met <br />sa-t Oct K d c <br />Department use Only <br />UNIT <br />e -'A q�sx�a3 �(p,,, ❑ Unit 1 <br />❑ Unit 2 110 - <br />Unit 3 <br />6. Street <br />be <br />XF ki Wz <br />7. Strut <br />01y <br />Unit'4 <br />0. <br />6. street <br />c <br />�' ❑ Unit 5 <br />9• S <br />a. <br />jo. sleet <br />ENVIRONMENTAL <br />HEALTH DEPARTMENT <br />FILESdare <br />Cd. UNDE=RGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />JA SOLID WASTE FACILITY <br />❑ SOLID WASTE VEHICLE <br />t <br />S& OTHER CLEANUP SITE (NON -LOP) <br />IR UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ FOOD FACILITY <br />❑ DOG KENNEL <br />❑ DAIRY <br />I <br />fd HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ MOTELlHOTEL <br />❑ PKG TREATMENT PLANT <br />13 PUMPER TRUCK/YARD/CHEM TOILETS <br />Cd TIERED PERMITTED FACILITY <br />E3POOMPA <br />❑LAND USE APPLICATION STIES <br />10 TATTOOIBODY PIERCING <br />❑ MEDICAL WASTE FACILFTY <br />❑ OTHER (PLEASE SPECIFY) <br />S lect the types) <br />of files from the list above by checking <br />1. List up to ten addresses in the space aoe, <br />v <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. END 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 . EH®staff prior to review. <br />at the expense <br />of the applicant. Future file reviews by the same applicant may require a $933.00 deposit p <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 />M. POIN11 <br />�}, PHOF <br />• i-'MY17•�' - <br />IIIA <br />v: <br />REM •• q : YE,� .. No RE1()EWi?A'ti .` <br />.... . <br />g-n�-o� :lift v:�► c�,,� ' �,2►i�c� ss, a" �ss,>cte 0a" . ss...�57s V ck,, ( y,ol� <br />s <br />TOTAL P.01 <br />