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DATE RECEIVED LHU LV V Numbum <br /> RECE `3 SAN JOAQUIN COUNTY <br /> �fLLj) ENVIRCENTAL HEALTH DEPARTmA <br /> 304 E Weber Ave 3rd Floor Stockton, CA 95205 <br /> FEB (4A)'W-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd I <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVVI.CET/ �I U-B/LIC RECORDS RELEASE/A/P�PLICATION <br /> APPLICANT: �II 1 /YI�AIoBUSINESSIAGENCY: ✓�C(/t-� �l1 ✓T I7/yt <br /> ADDRESS: S 75 C <br /> PHONE: FACSIMILE:_fl 3) <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> C3 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT/?STt•Ce l-t- �� �Q� DATE <br /> Departmen Use Only <br /> FILE ADDRESS UNIT <br /> 1. svee 3 '-/ ✓ 3$ 7 J� <br /> ❑ Unit 1 <br /> z. svee a o 0 o a '- qZD — _ 11�Ot <br /> ]. St 3�.3S-c: a '3 Unit' <br /> 4. Sheet 3 ,1 r{33 a +1 0 <br /> 5. shed 3 n /d [p a lk a Unit 3 <br /> 7. Sheet �—?' - 7 a <br /> > U <br /> S. sm .Z S 5- <br /> 9. sheet `C o a ❑ Unit 5 <br /> 10. sheet a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENTSOLIO WASTE FACILITY <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL OKDAIRY <br /> US WASTE GENERATOR ❑ CHICKEN RANCHPKG TREATMENT PLANT <br /> ElTIERED PERMITTED FACILITY E3MOTELIHOTEL L ❑ UMPERTRUCWYARDICHEM TOILETS <br /> ❑ TATTOOBOOY PIERCING ❑ POOLISPA ❑ 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 above 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. <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 /> s. '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 /> DATE CONFIRMED PHONE FAX fNITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 042406 <br /> VM003 <br />