Laserfiche WebLink
DATE RECEIVED EMU LUU NUM brK <br /> RECE"'V'S SAN JOAQUIN COUNTY Aob <br /> 'tvi <br /> EtIWI44ENTAL HEALTH DEPARTMOT <br /> 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> FEB(g A)UN-3420 Fax-: (209)464-0138 Web:www.co.san-joaquin.ca.us/ehd [jail <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICESPUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:--611-1 BUSINESSIAGENCY: <br /> ADDRESS: 7oq3-- jqno�o, q�l-vat <br /> PHONE: -7, FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) FEB -9 OQU <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT2—/zZ!!!,.- DATE <br /> Departmen(Use Only <br /> FILE ADDRESS UNIT <br /> ajfrK;3? -Fr", Atv--( �=- 0 Unit 4 <br /> 2. sutet 36600 _City --- 41 <br /> 0 3. Sh-W --4 �Sj City n" R nnn TV Ur,;, - <br /> 4. Sheet Z CKV III11II <br /> • 5. &MIA ON it 3 <br /> 6. Stild A-1-6 4, 0,44 <br /> ._( 8 q3' ;;" <br /> 7. Sheet 2-:9 23-7 uy Unit "qk <br /> a. sheet '2-9 <br /> 9. Street L--r CG ❑ Unit <br /> 10. skeet 2_ fj 4.f I_t- QI/ CiAd d& <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP (LOP) 1HOUSING ABA <br /> TEMENT t�-SOLID <br /> WASTE FACILITYUNDERGROUND <br /> ER CLEANUP SITE(NON-LOP) <br /> ® FOOD FACILITY :0-13 WASTE VEHICLE <br /> UNDERGR ND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL DAIRY <br /> UWASTE GENERATOR <br /> E3 CHICKEN RANCH KG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL SE3 LIMPER TRUCKIYARDICHEM TOILETS <br /> 13 TATTOOIBODY PIERCING 13 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> I List up to ten addresses In the space above. Select the type(s)of files from the list aboye 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 hold 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 /> ..-C,ONFI.RMED:APP61NTMENT DATE. TIME <br /> . PHONE FAX :---�:INITIALS <br /> DATE CONFIRMED <br /> REVIEWED = YES NO REVIEW DATE <br /> EHO 48-02-006 <br /> V81M3 <br />