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bi/1//'LbbS 1b:b8 10y3b'34228 NEIL ANDERSUN ENVIRU FAUL uliu <br /> ' EHD LOG N: .R <br /> �� D SANJOAQUIN (..C)UNI'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I> .z� j ii 2005 304 FS Weber Ave 3"1 Floor Stockton, CA 95205 <br /> (209) 468-3420 fax: (209)464-0138 Web: wtivw.co.san joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> -PERMIT/SERVICES PUBLIC IRIJCORDS RELEASF, APPLICATION <br /> APPLICANT: lINr --BUSINESSlAGENCY: � <br /> 1 �1V\ 1L:s. /La <br /> ADDRESS:— <br /> PHONE: <br /> DDRESS: �FAGSIMILE. <br /> PHONE: Om= '�(OI �)�0 <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> PN CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE–REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT a P A. DATE <br /> Department Use On <br /> FILE ADDRESS UNIT <br /> 1. :trrrl l GIIY t + Q Unit 1 <br /> z. street <br /> 3, street 1' <br /> 12 c,y�u 3S [ : ; Unit 2 <br /> Nj <br /> 4. SIrvM <br /> ��W1i�-? <br /> 5, Strrrt A[Q.a— �1,► �GAY N f <Unit 3 <br /> e. Street U. G city 11 <t <br /> 7. Slreel l� It t _ �Vnit 4 <br /> 9. Street _. 1.rtJ�--• � lty t• r' Unit 5 <br /> to. Street CI <br /> Iy <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 'K UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT d SOLID WASTE FACILITY <br /> VY OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> $L UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> J& HAZARDOUS WASTE GEN5RATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> *TIERED PERMITTED FACILITY ❑ MOTEUHOTEL zi PUMPER TRUCK/YARD/CHEM TOILI <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($) of files from the list above by checl ) <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209L!464-0138 or mail to t <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 fi <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review, A v <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 exp( z <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to ret Y. <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 day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> FMn AM'l.Anf. <br />