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07/29/2005 10:25 FAX 209 948062 Q002 <br /> ° I SMI D SA.N JOAQULN COTJNTY <br /> ENVM0N1VEENTAL HEALTH DEPARTNEENT <br /> JUL, 2 `j 2005 304 E Weber Ave 3'd Floor Stockton, CA 95205 1 <br /> 209) 468-3420 Fax: (209) 464-0138 Web: WWw.CO.sarljoaquin.mU5/ehd I U <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES pUJB'[.LIC RECORDS RELEASE APPLZCAT10N <br /> qlf <br /> APPUCANT; /it.tj C" 065 S flUSINESWAGENCY; I <br /> {{ e1— <br /> gnOftEsB: ,L <br /> PHONE: FACSIMILE: _ <br /> TENTATIVEAPPOINTMENT PATE: ✓J5 Time: <br /> (Pleaze allaw 10 business days from date of application submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-59100 FEE—REQUEST PROCESSED IN a BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT eoa a tt Use Only <br /> UNIT <br /> RLE ADDRESS <br /> . I F � G s ❑ � Unit i <br /> G k. <br /> ❑ Unit 2 <br /> s. s,2d <br /> kST H I s FL k Unit 3 <br /> DIST*1`") s, svm <br /> 4 e. swe Pei <br /> a <br /> Unit 4 <br /> H`U 1. so- ttt���111 � <br /> _M nit 5 <br /> G <br /> 10. SYcet a <br /> ENVIRONMENTAL HEALTH DEPARTMENT FINS S <br /> 12L SODU WASTE FACILT.TY O <br /> UNDERGROUND'TANK(UST)CLEANUP SrfE ROP) ❑ HOUSING ABATEMENT ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP STYE(NON-LOP) ❑ FOG KENNFACILEL <br /> IR-DAIRY <br /> a UNDERGROUNDTA14K(MONITORINGIREMOVAL) E] DOG KENNEL M_PKCTREATMENT PLANT <br /> Z HAZPRDOIJs wASTE GENERATOR L3CHICKEN RANCN <br /> ❑ <br /> ❑ MOTEI-MOTEL PUMPER I'RUCK/YAROICHEM TOILE-YS <br /> El TIERED PERMITTED FACILITY ❑ POOL/SPALAND USE APPLICATION SITES <br /> ❑ TATTOOIDODy PIERCING O OTHER(PLEASE SPErl" <br /> ❑ MEOICAI-WASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the types) of files from the list a6oye.hy checking <br /> - the appropriate box(es). At least One File type MUST be selected. Fax to 209 464-013fl or mail to the <br /> address indicated above, ointment for review well be confirmed <br /> 2, EHD will notify the applicant it any EHD files exist- An app <br /> approximately five business days but no later than ten (10) days after receipt of application. Then,— <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> a <br /> accordingly. <br /> 3. A file that is actively being worked on by END staff may not be immediately available for review. Ane <br /> application may be submitted when the file is availahle- <br /> q Any file not returned in the same condition as released will he 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 /> ..TIME j,s;a . Y.•'::.:3ii>:..,, - <br /> SG0NF,I,RMEE) APPOINTMENT. ATH! ' r:. <br /> FAX" <br /> ":i:;tlNfllALS x <br /> ...; '- <br /> DQTE 0 N 0Rh1 EO <br /> REVIEWED YES NO REVIEW DATE <br />