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Q002/002 <br /> 11/01/2004 12:10 FAX 209 9480"1 <br /> (� rIE <br /> I� WE <br /> DSAN JOAQUIN COUNTY <br /> In <br /> J f f�c 0 ENVIRONNIENz'AL HEALTH DEPAXTIAENT -D4 <br /> NOV - 1 2004 304 E Weber Ave 3`d Floor-Stockton, CA 95205 <br /> w <br /> (209)469-3420 Fax: (209)464-0138 Web: ww,Co.3an joaqukL=us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES pUBLIC RECORDS RELEASE AYPLICATIO <br /> APPLICANT: BUSIINIISSIAGENCY: ll�e►llt f <br /> ADDRESS �-$a�_ 1L_(=✓fyf }{P JIJYR : [rL�n C14 ��o�i7� <br /> PHONE: �f1G/ �X �'�� + ---FACSIMILE: aal Rye <br /> TENTATIVE*APPOINTMENT DATE: 11 f rove-( Time: <br /> (Please allow 10 business days from date ofappllc4on submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> z.r <br /> 1 zk.¢n ,.Unit 1 <br /> C111 Youlb, ILA <br /> z aced <br /> is - :t:_. IL's. dy <br /> 9-afo. �`-�, Unit 2 � 1 <br /> t, &.eel <br /> s s a Unit 3 <br /> 6. SIaM . <br /> 7 Stied Unit 4 <br /> Cky <br /> e. eked <br /> 9 Shea G Unit 5 <br /> Gtv -0 <br /> • ij�IM1� <br /> •ENVIRONMENTAL,HEATH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 51.SOL.10 WASTE FACILITY <br /> OTHER CLEANUP SITE=(NON-LOP) 0 FOOD FACILITY Q SOLID WASTE VEHICLE <br /> a UNDERGROUND TANK(MONITORINGIREMOVAL) O DOG KENNEL EL DAIRY <br /> Z HA7_ARDOUS WASE GENERATOR ❑ CHICKEN RANCH E••PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCWYARI)ICHEMTOILETS <br /> OLt`SPA a LAND USE APPLICATION SMEs <br /> Q TATTOOMODY PIERCING 0 PO <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPEC[F1r] <br /> 1. List up to ten addresses in the space above. Select the type(s)or fries from the list above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 Herr <br /> application maybe 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 rile reviews by the same applicant may require a$93.00 deposit prior to review <br /> 51 *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 /> '. .:Y,,rw r, ,. : • . TIME '`' '�'`''•� -• ..;•: : >:... <br /> CONkR..,MD APPOINTMENT DATE ::t :;•'.5;;�r.r `:%i?'::.' :`+�:'' <br /> ^- <br /> O 1R1VlELi I-PHONE FAX .•'•:.' TIAt=s <br /> 'DATE C NF.• ;' - <br /> REVIEWED ,= YES 'NO REVIEW DATE, '•• : =; <br /> EHD4442-0o6 <br /> .W6f140] <br />