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MAR -16-2007 09:01 COOR EARTH TECH • 209 532 0773 P.01i01 }, r_ I 17 "1v FLED ENMONMENTAL HEALTH DEPARTMENT MAR i 2C07 304 E Weber Ave 3`d Floor Stockton, CA 95205 (209) 468-3420 Fax: (209) 464-0138 Web: www.co.san joaquin.ca.us/ehd ENVIRONMEN 1 i1EAiTN 443 PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION ADDRESS; >%t462, "B Ato LANG PHONE: FACSIMILE: TENTATIVE' APPOINTMENT DATE: nrI+JCompleted (Please allow 10 business days from date of appllcatlon submittal) L -a CHECK BOX TO EXPEDITE REQUEST - $93-00 FE - REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT DATE ENVIRONMENTAL, HEALTH DEPARTME=NT FILES 16 Deparlme't Use Only p Unit 2 Unit 3 Unit 4 �A UNDERGROUND TANK (UST) CLEANUP SITE (LOP) W HOUSING ABATEMENT pid SOLID WASTE FACI6V( OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY F+ SOLID WASTE VEHICLE 1@! UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY �l HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH 0 PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL M PUMPER TRUCWARDICHEM TOILETS ❑ TATTOW13ODY PIERCING ❑ POOLISPA 13 LAND USE APPLICATION SITES 9Z MEDICAL WASTE FACILJTY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2, EHD will notify the applicant if any EHD files exist, An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be Schad iled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at th expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prix to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day, CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS' REVIEWED YES NO REVIEW DATE TOTAL P.01 FILE ADDRESS �. sreee GI S82 & I V city DZACoq 2. such O " aty 3. s�am a l Rb city a.�.<. Ch s. S�kN S. c A Izr R . a 6. S2 2 L. f0 -�' ,. s [ . T ON N F.F- a . s W Or VV.. 161HIr6HAL.4- &D KA a •f•F. .f.F. �a. Street A aA3 II MCky�.F. F. ENVIRONMENTAL, HEALTH DEPARTME=NT FILES 16 Deparlme't Use Only p Unit 2 Unit 3 Unit 4 �A UNDERGROUND TANK (UST) CLEANUP SITE (LOP) W HOUSING ABATEMENT pid SOLID WASTE FACI6V( OTHER CLEANUP SITE (NON -LOP) 13 FOOD FACILITY F+ SOLID WASTE VEHICLE 1@! UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY �l HAZARDOUS WASTE GENERATOR 17 CHICKEN RANCH 0 PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILITY 0 MOTELIHOTEL M PUMPER TRUCWARDICHEM TOILETS ❑ TATTOW13ODY PIERCING ❑ POOLISPA 13 LAND USE APPLICATION SITES 9Z MEDICAL WASTE FACILJTY ❑ OTHER (PLEASE SPECIFY) 1. List up to ten addresses in the space above. Select the type(s) of files from the list aboye by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209) 464-0138 or mail to the address indicated above. 2, EHD will notify the applicant if any EHD files exist, An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be Schad iled accordingly. 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at th expense of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prix to review. 5. *TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day, CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS' REVIEWED YES NO REVIEW DATE TOTAL P.01