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I <br /> Sep 02 05 09: 34a PiF 400--'9-1224 P. 1 <br /> R='VEDD <br /> i EMD LOG NUMBER <br /> SAN JoAQUnv Covnrry <br /> SEP _ ZQ�� ENVIRONMENTA.LHEALTH DEPARTMENT <br /> 304 E Weber Ave 3"1 Floor Stockton, CA 95205 <br /> E ENVIRONMENT NR�W68-3420 Fay:: (209)464-0138 Web: www,co.san-joaqujn_ca.us/ehd <br /> r PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESS/AGENCY: �k5n✓t rU/l/VlpyE,ti�7_SeUl <br /> ADDRESS: kl__,D� S. S C©M A,,-e- f , �G�✓L�O�� CA 9-5-21 _ J <br /> PHONE: �L/l5 I G`E o�CD� _ FACSIMILE: <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 94 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93 00�ErE�-REQUEST <br /> ,.,P�ROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE -� <br /> Departmenf Use On[y <br /> FILE ADDRESSUNIT <br /> z. street 5 H El Unit 1 - � <br /> 3. street EZ74 WTYA <br /> ^ -k E] Unit 2 <br /> / <br /> S. Street aty ` <br /> Unit 3 <br /> ( <br /> a. street .�3 t cit GL �r <br /> 7. Sseel �IrX54 W V d j <br /> a f Unit <br /> D. Slrnet � ' <br /> 9. Street �, {.. Q 1 •.t n Y <br /> ❑ Unit 5 <br /> 16. 5tree1 r} <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,E UNDERGROUNO TANK(UST)CLFAMU13 SITE(LOPI ❑/HOUSING ABATEMENT ❑ SOLID WASTE FACfLrrY <br /> -0—OTHER CLEANUP sITE(NON-LOP) Cl FOOD FACILITY ❑ SOLID WASTE vzmlCLE <br /> 11HDERGROUND 7ANK{MO NITORINGlREMOUAL} D DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH I7 PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑:MOTELIHOTEL M PUMPER TRUCK/YARD/CHEM TOILETS <br /> ❑ TATTOGIBODY PIERCING M 1POOLISPA 0 LAND USE APPLICATION STIES <br /> 0 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 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-0136 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 j <br /> will be held for a maximum of five business days for review. Appointments should be scheduled I <br /> accordingly. <br /> 3. A file that is actively being worked on-by EHD staff may not be Immediately available for review. Anew j <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 /> 1 <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD e6-02-005 'I <br /> El@I291f7 4 <br /> I <br />