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ENVIROA9ENTALHEALTH PAGE 01 <br /> g D Y2e04 . 14:50 4640138 hmu lW hUMDCR <br /> >AT tlt� 9 r J D� SAN JOAQUIN COUNTY <br /> MAY 1 1 2004 ENVIRONMENTALHEALT'HA 'T <br /> EFARTMENIg/3 <br /> 304 E Weber Ave 314 Floor Stockton,CA 95205 ca uslehd <br /> ENV]RONMERIQM lI3420Fax' (209)46A-0138 Web:www.co.sanJoaquin• <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> n l - BUSINESSWENCY: S Tk <br /> (rAPPucANT:Scp— �A- 9a"o8z <br /> HONE: �7, FACSIMILE: <br /> ~ O�etC �1�AIO P ✓ Time: p.0a <br /> TENTATNE"APPOINTMENTDATE: <br /> � _ -�— <br /> (please allow 70 business days from data of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST'$53.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE II oy <br /> SIGNATURE OF APPLICANT j ✓ w Dep tmbntUs*Only <br /> UNIT <br /> FILE ADDRESS <br /> ❑ Un?t 1 <br /> to l 5, w t W <br /> 5 bck <br /> smet D 5. W: G/ 0 5 !vn Unit �� <br /> s. Streel S <br /> ,. y,� ✓�08 S S Unit 3 <br /> , l G <br /> oN Unit 4 <br /> r. sneer <br /> L 9met <br /> 9. .S'Ired Lttv . <br /> Ia. 5 tet <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HpUSIN6 ABATEMENT ❑ SOLID WASTE FACILITY <br /> jjjyyyJJJjjj��� UNDERGROUND TANK(t13TJ CLEANUP SITE(LOP) ❑ FOOD Mr ABT - ❑ SOLID WASTE VEHICLE <br /> OTHER CLE4NUP SITE(NON-LOP) a DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MONrrOfuNGIREMOVAL.) ❑ C; MN RANCH ❑ PKG TREATMENT PLANT <br /> Q' HA7,ARDOUS WASTE GENERATOR R MOTEUHOTEL ❑ LAW USTRUCKICATION SITES TOILETS <br /> O jmRED PERMrrMP FACILITY 'p poouSPA O MND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING cl OTHER(PLEASE SPECIF1f) <br /> O MEDICAL WASTE FACMY <br /> s of flies from the list above by checking <br /> be Selected. Fax t0 209 464.0138 or mail t0 the <br /> � L;st up to ten addresses;^the space above. Select the type.( <br /> the appropriate boxes}. At(east one file type MUST <br /> address;ndicat®d above.. y o;ntrtten!for review will be confirmed <br /> 2 EHD will notify the appllcant;f an EHD fifes exist An aPP <br /> Intments should be scheduled <br /> approximately five business days but no later than ten(10)days after r®ceipt of <br /> cation. The Les <br /> will be held for a Maximum of five business da for review. APPo <br /> accordin9lY• EHD staff may not be immediately availabEe for review. Anew <br /> 3. A file that is actiVety being worked en by <br /> application may be submitted when the fila is available. s14 prior to review. <br /> se <br /> 4• Any fila not returned in the Same COnditNte sa ereleased app ant may req i e�aStaff p the eli <br /> o r$93.00 deposit <br /> of the applicant Future file reviews by <br /> 5. 'TENTATIVE appointment dates mUwlb be p essedthe next business day. <br /> S. Appl;cations received after 3:00 Pm <br /> TIME <br /> GONF1kMEp APPOINTN;ENT DATE PHONE . FAX INITIA!S DATE CONFIRMED REVIEW DATE <br /> REVIEWED <br /> YES NO <br /> ,Ho eaZ�Co6. <br /> EROS] <br /> 0/10 39Vd dI-jtlO ON snivNlS 90099L90E9 94:45 400Z/ 1/90 <br />