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��, ��. �' •••• .....,. +�� a�� 1� EHD LOG NUMBER <br /> V nL J 12 SAN JOAQUIN COUNTY _.. <br /> �uDu Icmu ENVIRONWNTALHEALTHDEPARTMENT <br /> 4 304 E Weber Ave 3,d Floor Stockton,CA 95205 1 <br /> MAR 5 200(209)468-3420 Fax: (209) 464-0138 Web:www.co.san-}Gaquin ca us/ehd {11 <br /> ENVIR0vEW HEALTH <br /> PERMIT;SERVIGES PUBLIC RECORDS RELEASE �APPLICATION <br /> Y �,VI_C Gl,t/L- BUSINESS/AGErNCY; 'n APPLICANT. <br /> 11te Q I" <br /> ADDRESS: <br /> FACSIMILE: <br /> PHONE: lrli-t / 4 ^ �, <br /> 1 Ii ck� Timer p <br /> TENTATNE'APPOINTMENT DATE: <br /> V V�{� ^ �c <br /> (Please allow 10 business ays <br /> hom date of e p auhmlttal) 1.i A q �' <br /> CHECK BOX TO EXPEDITE REQUEST 193.00 FEE-R UEST PROCESSED IN 3 BUSINESS DAYS <br /> _ DATE <br /> SIGNATURE OF APPLICANT <br /> Department Use Only <br /> P <br /> FILE ADDRESS <br /> 2.•so-ee+ I <br /> 1,11 l <br /> 4. s� 2 - <br /> 5 6eev <br /> 7, SreN <br /> e sa. C <br /> e. s <br /> ,a. Svaa <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 9� <br /> ❑ HOUSING ABATEMENT ;>d SOLID WASTE FACILITY <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ FOOD FACILITY �) SOLID WASTE VEHICLE <br /> THER CLEANUP SITE(NON-LOP) ❑ DOG KENNEL - ❑ DAIRY <br /> UNDERGROUND TANK ORINGIREMOVAL) 13 CHICKEN RANCH PKG TREATMENT PLANT <br /> OHAZARDOUS WASTE GENERATOR ❑ PUMPER TRUGKIYARDICHEM TOILETS <br /> TIERED PERMITTED FACILITY r3POOLISPA�L OL LAND USE APPLICATION SITES <br /> ❑ TATTOOIBODY PIERCING ❑ OTHER(PLEASE SPECIFY) <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 -y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209) 484-0138 or mail to the <br /> address indicated above. pointment <br /> apj <br /> 2. EHDwin fYf a business days but applicant if any oo later than tfiles exist. en(10) days afterreceipt of application. The files <br /> approximately <br /> will be held for a maximum of five business days for review. Appointments should be schedule <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A nev <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 expens( <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviev <br /> rn <br /> g, 'TENTATNE appointment dates must be confirmed with EHD staff. <br /> 8. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE <br /> TIME <br /> DATE CONFIRMED <br /> PHONE FAX INITIALS <br /> REVIEWED - <br /> YES NO REVIEW DATE <br /> E w 4emme <br /> Ill <br />