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DAT <br />-(ME VAPID <br /> <br />2 3 2006 <br />EHD LOG NUMBER <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT 2 <br />304 F. Weber Ave 3 Floor Stockton, CA 95205 <br />ENViRO NmEN M1-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/eh <br />PERMIT/SERVICES <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: Tack. CASAA.Q.0 BUSINESS/AGENCY: /Ue.11 /177.&-1/7 v4.5.5oeia <br />ADDRESS: CIOZ <br />PHONE: (POI FACSIMILE 50 1122 ?- <br />TENTATIVE* APPOINTMENT DATE: <br />(Please allow 10 business days from date of application submi <br />174 CHECK BOX TO EXPEDITE REQUEST - $93.00 FEE — REQUEST PROCESSED IN 3 eusiNEss DAYS <br /> <br />SIGNATURE OF APPLICANT ritPAok, Cit OAL..04,1 <br />FILE ADDRESS <br />. Street 2C7G I wa4c r Voe, criy $40c-rrivt,‘ ..?,...1 b t-fi- <br />2 Street ,aG.5..1 IA...)4, 4e re 100 City SitXXatiztv <br />, SIrrpll i B-700! 2. T--toer cP.ek Clly kiT0A.,_ A) J--- 1 r-- <br />4, Street CI <br />Slreet A <br />6, Sireci ,g <br />7. Sr 4,treet <br />O. Street City <br /> Street Clly <br /> Street Clly , .... <br />ENVIRONMENTAL HEALTH DEPAR1WNT FILES <br />apartment Use Only <br />UNIT <br />Unit 1 <br />LI Unit 2 <br />4i Unit 3 <br />DATE <br />Gi/,. UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />1g. OTHER CLEANUP SITE (NON-LOP) <br />lie/UNDERGROUND TANK (MONITORING/REMOVAL) <br />Dr/HAZARDOUS WASTE GENERATOR <br />CV TIERED PERMITTED FACILITY <br />TATTOO/BODY PIERCING <br />MEDICAL WASTE FACILITY <br />0 HOUSING ABATEMENT <br />FOOD FACILITY <br />DOG KENNEL <br />CHICKEN RANCH <br />MOTEL/HOTEL <br />POOL/SPA <br />OTHER (PLEASE SPECIFY) <br />SOLID WASTE FACILITY <br />SOLID WASTE VEHICLE <br />DAIRY <br />PKG TREATMENT PLANT <br />CI PUMPER TRUCK/YARD/CHEM TOILETS <br />LAND USE APPLICATION SITES <br /> <br />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 pr mail to the <br />address indicated above, <br />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 />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 />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 />*TENTATIVE appointment dates must be confirmed with EHD staff. <br />Applications received after 3:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EFID .41-02-00c <br />eier-,1,003