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SAN JOAQtiIN C(.Jlli`i i Y <br /> RONMENTAL HEALTH DEPARTif'NT <br /> ? E Weber Ave 3rd Floor Stockton, CA 9, <br /> APR 0 6 �(�g�) 468-3420 Fax: (209) 464-0138 Web: Nvw-w.co.san_joaquin.ca.us/ehd <br /> ENVIRu`ilvl`id I HEALTH <br /> PEMMIT/SERVICES PUBLIC RECORDS RELEASE APPLAICATION <br /> APPLICANT: e, rSZ ,dert— BUSINESS/AGENCY: AT <br /> ADDRESS: 11 1-7 LOh� Pal-, Ave , Sv,?e-& /`'Ivr ,4, cA <br /> PHONE: ZO9" S744-2221 FACSIMILE: �J9 S�`1'2225 <br /> i <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) D <br /> G CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS o <br /> SIGNATURE OF APPLICANT DATE - <br /> XIV Department Use Onl <br /> UNIT <br /> p c� FILE ADDRESS 1 <br /> GN S 1 ❑ Unit 1 <br /> G <br /> 606 S. �(✓ o✓ w1 ` Sto:JC�� <br /> 2. Street t/ <br /> 3. Street //611 V 5. ir o� W� Gr Sfioa� h Unit 21 \ <br /> 4. Street U 122. 5. A�ir o" W GN S C'C o �� <br /> 5. Str t 6OZO 5• v WA Ci 5t_0ck MI-,:- Unit 3 <br /> tree( 200 <br /> 7. Street /s�3 S. i v+l �•. CN s t k�" It 4 <br /> 8. S"'!t 1 ICIG, S. Qr t✓ a r,./ ��� < / <br /> 9. Street <br /> 7 r>-1 S• i✓ o V�� Gc ra�t�� 3 S QS ❑ Unit 5 <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �•.. ? <br /> ❑ HOUSING ABATEMENT SOLID WASTE-FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ SOLID WASTE V1ICtt= <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY <br /> UNDERGROUND TANK(MON ITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1:1 TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> 11TATTOOIBODY PIERCING 11POOL/SPA 11 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 /> 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business dar�'."__)_ -" l <br /> CONFIRMED APPOINTMENT DATE TIME - <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EHD 48-02-006 _ <br /> 6/8/2003 <br />