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o;f/cz/zuob ii :za IAA 166002/002 <br /> C-, , SAN JOAQUIN COUNTY <br /> Di NV�ONMENTAL HEALTH DEPARTMENT <br /> MAR - 2 2006 304 E WeberAve 3"Floor Stockton, CA 95205 ZZ, <br /> ENVIRONIMENT 1-IEARP) 466-3420 Fax: (209) 464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> PERMIT/SERVICES puBLIC RECORDS RELEASE APPLICATION <br /> APPL]CAN'i: Rnrr tf�f SIVA BUsimi:=AGENCY: LLe4le''(� -- <br /> ADCRESS: a� FYc(Z7l.E ST_ "'" •••�_► - <br /> PHONE: nQ r ,ye"'l2i ya FACS1MILe: <br /> TENTATIVE'APP01"ENT DA7F; A) <br /> (Please allow 10 buSinesa days froth date of apPlfmfion submietaq <br /> CHECK BOX YO ExP£DRE REQUEST-$93.00 FEE <br /> n-REQUEST PROCESSED IN a BUSINESS DAYS <br /> SIGNATURE OFAPPLICANT M�Ga1A/ DATE 'Ji/2�fXIJ <br /> Department Use onM <br /> UNIT <br /> FILE ADDRESS <br /> s 9Nit ) ❑ Unit 1 <br /> F: <br /> Unit 2 <br /> i suw t" <br /> Unit 3 <br /> Unit 4 <br /> svw+ <br /> ' ❑ Unit 5 <br /> la sera !_ <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ✓ UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HousING ABATEMENT eI-SOLID WASTE FACIUY <br /> OTHER CLEANUP Sr(c(NON-LOP) <br /> ❑ FWD FACILrrr C3SOLID WASTE YEHIGL£ <br /> M DOG KENNEL EL DAIRY <br /> Z - <br /> UNDERGROUND TANK ENERAOR3NGlREMOVAL) ❑ CHICKEN RANCH 9-PKG TREATMENT PLANT <br /> NAZsRfJOUS WASTE GENERATOR ❑ MO-MI-MOTEL ❑ FUM PER TRUCKIYARD'CHEM TOa.EiS <br /> ❑ TIERED PERMRTED FACILITY Cl POOLSPA a LAND 1.5E APPUCATON SITES <br /> ❑ TAYTOOtSOm PIERCING Cl OTHER(PLEASE SP£CV-0 — <br /> ❑ MEDICAL WASTE FACILITY <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. EHO will notify the applicant if any EHD files exist- An appointment for review will be confirmed <br /> approximately five business days but no tater 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, Afile that is actively being worked on by EHD staff may not be immediately available for review. 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 <br /> a$93.EHDathe expense <br /> to review. <br /> of the applicant Future rile reviews by the same applicant may reqdepositprior <br /> 5. `TENTATIV•E appointment dates must be confirmed with EHD staff, <br /> 6• Applications received after 3:oo pm will be processed the next business day. <br /> ��_- _ • f sr'� <br /> C NF1F lyt <br /> TRC11NiM NT '} y-<„ ,TIME <br /> lwDj1R E �A7E''. �:o - <br /> =4 <br /> REVIEW DATE <br /> REVI.Ev1ED YES NO ,_ <br />