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7 004 46FM 'f Q Anderson & As N 2 <br /> y SOC• I 1� ML�� s �IF VL:� <br /> 5A1v.�oAc��IN CovN�rY _ <br /> li <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> FEB 7 200 304 E Weber Ave 3`a Floor Stockton', CA 95205 <br /> ENVIRONMENT WZf A68-3420 Fax: (209) 464-0138 Web: www_co.san-.oaquin.ca.us/ehd <br /> PERMIT/SERVICES ,. <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: r1��1 (24LC1t_V t� _' y Y" _. BUSINESSfAGGE�NCY: tom`! " ''Ay\.& nrS r,-A <br /> d` ADDRESS:_ 9��- V,,AVS4A& � i <br /> _ I4(U 1 5 -`_72r -1. _ <br /> PHONE: 16(Q'- -3-+01 - FACSIMILE: 3u9 - f 2 9 <br /> TENTATIVE'APPOINTMENT DATE: 31 Z J 4'i �5 Time: - A►1h <br />! (Please allow 10 business days from date of application subminat} <br /> I <br /> I CHECK BOX TO EXPEDITE REQUEST-$93.00 FE _REQ UEST PROCESSED IN 3 BUSINESS DAYS <br /> I� 1 <br /> SIGNATURE OF APPLICANT IF DATE <br /> i? Oe:)artment Use Only <br /> FILE ADDRESS ii UNIT <br /> ,. Street 3 3 W• Yi,n,� S�. e+ j��; ❑ unit 1 <br /> 2. street 2-30 Ind sS i� ev-\ 'r.AA—. <br /> li 3 <br /> 2 S•� , c �c.tD <br /> 2 V� <br /> 3 W• as unit 2 <br /> 3. Street ❑ a <br /> s. street <br /> s. sine+ X13 - -� City Unit 3 e <br /> 6. SVeel <br /> sueec W- 1h, o a I li Unit <br /> ' <br /> 8. street 334 I� ►!m a <br /> s. street 3 1 - Y4la n S-1 . ✓ , tiY� I <br /> Unit <br /> p Ca 0 1a Acvt c. �• It <br /> tr<� 3 `� <br /> �o. 5 e <br /> F .F <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> I'Il <br /> 10 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT jig ❑ SOLID WASTE FACILrTY <br /> l OTHER CLEANUP SIT£{NON LOP} 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MO NITORI NGIREM OVAL) 0 DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ID CHICKEN RANCH1 0 PKG TREATMENT PLANT ' <br /> 0 TIERED PERMITTED FACILITY Q MOTELIHOTEL 'i PUMPER 7RlfGK/YARDlCHEM TOILET: <br /> C3TATTOOIBODY PIERCING I'3 I'OOLISPA � CI LAND USE APPLICATION SITESi <br /> C3 MEDICAL.WASTE FACILITY 0 OTHER{PLEASE SPECIFY) — <br /> �, List up to ten addresses in the space above. Select the type(s) of'files from the list above by checkil <br /> the appropriate box(es). At least one file type MUST be set lected. ',Fax to 209 464-0138 or mail to th- <br /> address indicated above. 6 <br /> 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed <br /> approxiinately five business days but no later than ten(40)jdays after receipt of application- The file <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. if <br /> 3. A file that is actively being worked an by EHD staff may not be immediately available for review. A r <br /> application may be submitted when the file is available. �+ <br /> 4, Any file not returned in the same condition as released wilt be reorganized by EHD staff at the exper <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rev <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 /> ij <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE i1FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> 879x1043 <br />