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Sep 02 05 09:34a pi s <br />D - <br />�h�-i��� <br />408- 9-1224 P. <br />EHD LOG NUMBER <br />SAN JOAQUTN COUNTY <br />SEP - 2 2005 ENVIRONMENTAL HEALTH DEPARTMENT <br />304 E Weber Ave 3`d Floor Stockton, CA 95205 <br />ENVIRONMENT HRV11 68-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.cams/ehd <br />PERMIT/SERVICES <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: ? C/C/Y �� 1 BUSINESS/AGENCY: Itl� �� �l rU /I�__o <br />ADDRESS: J� .�• Ao SCoM AU-? 4 r� , �[i�/L .` n �P C�/4 G�I�R ��i�� �� w <br />PHONE: FACSIMILE: _)_DL (4 <br />TENTATIVE" APPOINTMENT DATE: Time: VI <br />{Please allow 10 business days from date of application submittal) <br />.CHECK BOX TO .. DAYS <br />SIGNATURE OF APPLICANT > wog ' <br />INFt ffo ,% Veserr.-OM.Y A<' - <br />iir/,=C�f� <br />�■�rAM.r ANWIS i <br />kU-1- pd <br />W <br />i <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />0O o <br />vi z -of, <br />Department Use Only <br />UNIT <br />❑ Unit 1 <br />❑ Unit 2 <br />Unit 3 <br />,PeUnit 4 <br />❑ Unit 5 <br />.O UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />❑ HOUSING ABATEMENT <br />❑ SOLID WASTE FACILITY <br />-H'OTHER CLEANUP SITE (NON -LOP) <br />❑ FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNDERGROUND TANK (MONITORINGIREMOVAL) <br />❑ DOG KENNEL <br />❑ DAIRY <br />,0 --HAZARDOUS WASTE GENERATOR <br />❑ CHICKEN RANCH <br />❑ PKG TREATMENT PLANT <br />❑ TIERED PERMITTED FACILITY <br />❑ MOTELIHOTEL <br />❑ PUMPER TRUCKIYARD/CHEM TOILETS <br />❑ TATTOOISODY PIERCING <br />❑ POOL/SPA <br />❑ LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />1. 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 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 new <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 expense <br />of the applicant. Future file reviews by the same -applicant may 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 />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EHD 46-02-006 <br />811V2003 <br />