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DATE RECEIVEDSAN JO COUNTY EHD LOG NUMBER <br /> LLJ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> SEP 14 20 0 0 <br /> (QL�9) 468-3420 Fax: (209)464-0138 Web:www.co.sanjoaquin.ca.us/ehd el <br /> ENViRMNIEN1 HEALi H <br /> PERMIT SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 'l BUSINESSIAGENCY: <br /> ADDRESS( J Aac- <br /> Q OgOV Lam„ <br /> PHONE: ` `�" FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> u CHECK BOX TO EXPEDITE REQUEST-Ee3 —REQUEST PROCESSED IN 3 BUSINESS DAYS - <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNI <br /> /o <br /> I. street- 2 Pot f Gsl — - G o ,295 p -unit t <br /> 2. street 12 o In sr Ibpy <br /> 3. Street. 000 N. d/tit O LUnit2- <br /> 4 •. Street �( YY, t N G �� <br /> 5. street aty <br /> 6. Street aty <br /> 7. street aty TUnite. creel9. street 10. street atyENVIRONMENTAL HEALTH DEPARTMENT FILE'Sf; <br /> Lsl// NDERGROUND TANK NST)CLEANUP SITE(LOP) �OUSING ABATEMENT �_�50LID WASTE F <br /> OTHER <br /> P SITE(NONJI-OP) 0 FOOD FACILITY <br /> SOLID WASTE VE L <br /> n,,UNDER�G UW DP TANSTE (MONtTO INGIREMOVAL)ENERATOR 13 DOGCHICKEN KENNREL C3 PAG YTREATMENT PLANT <br /> C❑ TIERED PERMITTED FACILITY ❑ MOTELIHOTEL 4T PJAMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA VILAND 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 ame condition as released will be reorganized by EHD staff at the expense . <br /> of the applicant. Future file ewe by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment atesust be confirmed with EHD staff. <br /> 6. Applications received afte pm will be p cesse .th afc t'tush ss 4 <br /> CONFIRMED APPOINTMENT D <br /> DATE CONFIRMED 'HONEFAX NITIALS <br /> REVIEWED YES NO '� °; RE1)IEW DATE <br /> - e <br /> EHD 48-02-006 '. <br /> 8/8!2003 <br />