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•07 03 06: 14a Matt Milnes <br /> 415-468-9250 j. <br /> �1041kt�� 4� 464013 P <br /> � ENVIRONW-WAL HE� <br /> __ I PAGE 01 <br /> \ SAN JOAQUIN COUNTY EHD LOCI NUMUER <br /> t 0 V 1 0 2003 JEWIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3'Floor Stockton, CA 95205 I <br /> EN'VIRANIE'NI HEAL(409) 468-3420 Fax: (209)464-0138 Web: www.Co.san joaquin.caus/ehd ' <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; / 1� s3usmrssfAGENCY: <br /> �F- ADDRESS: <br /> p `J�y <br /> HONE: ���' y�/ JL % L F IMILE: 7 -i FrJS <br /> 9'N>~ <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Plea9e allow 10 buslness days from date of application 9ubmitlalj <br /> PI/CHECK BOX TO EXPEDITE REQUEST•f9 FEE— QU ROCE WIN' 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE / <br /> i <br /> Dapartmenl Use Only <br /> FILE ADDRESS UNIT <br /> 1 swel 1,i- ; = } U H C.'4' Unit 1 2, <br /> ]. saen 197 15 <br /> 4 ArtN G Unit 3 <br /> B. arcaa p <br /> a. 9lreel <br /> m. sal cl r,n„ ,Uni�l5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT^FILES L <br /> rNDERGROUNDTANK(UST)CLEANUP SITE(LOP) HOUSING ADATEMENT Wsom WASTE FACILITY <br /> ERCLEANUPSrfE(NON-LOP) FOOD FACILITY 6 SOLID WASTE VEHICLE <br /> ROUNDTANK(MONITRINGREMOVAL) ❑ DOG KrNNEL ;ZDAIRY <br /> ARDOUSWASTE GENERATOR CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ERED PERMITTDFACILITYMOTELIHOTEL ,f2f LIMPER TRUCIWARDfCHEMTOILETATTOOIDODY PIERCING ❑ POOL/SPA .0 LAND USE APPLICATION SI7E3 <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> I. 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 fora maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A rile that is actively being worked on by EHD staff may not be Immediately available for review. A now <br /> application may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released win 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 /> G. Applications received after 3:00 pm will be processed the next business da <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EM Y-03{M <br /> NYSa03 <br />