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DATE RECEE�I.V}ED IzHU TUU t�urn=K <br /> 1 ECE <br /> IJ LJ � }SAN JOAQLUN COUNTY <br /> ENVIE. MENTAL HEALTH DEPARTMF <br /> p 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> FEB(M)20-3420 Fax: (209)464-0138 Web: www-co.sa4-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICETUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: t BUSINESSIAGENCY: <br /> ADDRESS: S I <br /> PHONE: FACSIMILE: `3 2--0 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) I <br /> CHECK BOX TO EXPEDITE REQUEST•$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT t.�� �- DATE <br /> DeDartmen Use Only <br /> FILE ADDRESS UNIT <br /> stree r(03? 7r- v- 3 5 7 T <br /> ❑ Unit i � <br /> 2. saeec 36600 A aty <br /> 3. Street 3C.3 3 C rity U nit" } <br /> 4. Street v -?SCAY <br /> jpet <br /> s. sweet -3 a Ci O (� oty C2 � Unit 3 <br /> 6. streetr $ / I4 tr �f�L'1�-r Ci r�_D . <br /> 7. Street 7-02-3-7 9_q Z <br /> B. Street �2"9 - cdy (; � <br /> 9. saeel Q city ❑ Unit S <br /> 10. Street *a- CY Lf oty <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> tNDERGROUND TANK(UST}CLEANUP SITE(tOP) ❑ HOUSING ABATEMENT {SOLID WASTE FACfLfTY <br /> ER CLEANUPSITE(NON-L.OP) ❑ FOOD FACILITY SOLID WASTE VEHICLEERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL AIRY <br /> US WASTE GENERATOR 0 CHICKEN RANCH KG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUROTEL R13�UMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TATTOOIBOOY PIERCING ❑ POOLlSPA ❑ LAND USE APPLICATION SITES <br /> ❑ 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 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 held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. . 1 <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 /> :CONFIRMED,0611 TM 'DATE TIME <br /> :DATE CONFIRMED. `:PHONE FAX' 1NlT1ALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 - <br /> er VM3 u <br />