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EFEIVFf) <br /> ti _ .i'i' '—'r� EHD LOG NUMBS <br /> l J `-,�E:�1�',,Jr S"; SAN.TOAQUIN COUNTY R . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> AUG 3 1 2004 304 E Weber Ave 3rd Floor Stockton, CA 5205 <br /> (209))468-3420 Fax: (209)464-0138 Web: www.co.lanjoaquin.ca.us/ehd <br /> ENV1R0i-?vlEidT F ALTFi l <br /> PERNIIIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 1 BUSINESS/AGENCY: It i <br /> ADDRESS: <br /> PHONE: FACSIMILE: <br /> i� <br /> TENTATIVE'APPOINTMENT DATE: i' lTime: <br /> (Please allow 10 business days from date of application submittal) <br /> ❑ I b <br /> CHECK BOX TO EXPEDITE REQUESI� 93.00 FE REQU ST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT T, !# I DATE <br /> Department Use Only <br /> FILE ADDRESS I{ ;j UNIT <br /> 1. sheet t a �,00 I{ ,t <br /> i We.. � q El Unit 1 <br /> Il, <br /> 3. street a Ib <br /> Unit 2 <br /> 1. Street city it <br /> S. Steel cityIE j <br /> 6. Sleet atyII k <br /> i I <br /> 7. Sheet ON It Unit <br /> 8. Street Dty <br /> t <br /> e. street Unit 5 <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) X HOUSING ABATEMENT k i❑ SOLID WASTE FACILITY <br /> �1 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> R( UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ild DAIRY <br /> Iq HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH '❑ PKG TREATMENT PLANT <br /> 44 TIERED PERMITTED FACILITY D MOTEUHOTEL 1❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOO/BODY PIERCING ❑ POOUSPA I LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SP--11T11 1 <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above liy checking <br /> thea appropriate box(es). At least one file type MUST be selected.;Fax to (209)464-0138 or mail to the <br /> pp i <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 j <br /> will be held for a maximum of five business days for review. Appointments should be scheduled 1 <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 maybe submitted when the file is available. 1� <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 applicantpay 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 day. <br /> C.QNFIRM ED APROINtMENT.DATE,, . TIME r.. <br /> DATE CONFIRMED <br /> PHONE I�FAX <br /> REVIEWED YES NO REVIEW DATE <br /> EHO18-02-006 � I1 tt <br /> N6f2t107 : 1 �Ifll ' <br />