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R EHD LOG NUMBER <br /> �E�L <br /> VIED <br /> SAN JOA.QUIN COUNTY* <br /> u I LSD Ei NVIRONMENTA,L HEALTH DEPARTMENT <br /> Nil VLO 304 E Weber Ave 3"'Floor Stockton, CA 95205 <br /> i <br /> 09)468-3420 Fax: (209)464-0138 Web: www.co.san joaquin.ca.us/ehd � 9 <br /> ENVIRONNIIENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICA'T'ION <br /> APPLICANT:(j`T OO 19]�kP/YL—S4 BUSINESS(AGENCY: <br /> ADDRESS:. goZ22''ly) <br /> PHONE:—Aa&7-3-101 0 FACSIMILE; 17�J"l �� <br /> TENTATIVE*APPOINTMENT DATE: — ( W 1•I•p'7 Time:A_ <br /> (Please allow 10 business days from date of application submittal) <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE--REQUEST PROCESSED INS BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ll Zz 07 <br /> Department Use Only <br /> FILE ADDRESS C UNIT <br /> 1. fimel 5-151 M L .0 �J <br /> 2. Skeet W�n Glfi') C �'v"� Gt '�G '�•�✓N Unit 1 <br /> 3. Street OV - t �"it4. GI �i� Unit 2 '�A5 <br /> 4. Street Q r S Q- GI <br /> s. skeet 7 S17 f�eV Q� Gt �vc k� t Unit 3 <br /> S. Stet 110 1Gt G 1 e\u� City, S"wG *4 <br /> >. slrtel cit Unit 4 <br /> 00, <br /> e. $Imra CII <br /> 9. Sireel city Unit 5 <br /> 10. Street G <br /> �/ ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> G7 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FACILITY <br /> L(OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> a.7//UNDERGROUND TANK(MONITORING/REMOVAL) ❑ DOG KENNEL O DAIRY <br /> f9 HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 17 TIERED PERMITTED FACILITY 0 MOTEUHOTEL ❑ PUMPER TRUrWARD/CHEM TOILETS <br /> ❑ TATTOOIBOOY PIERCING O POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <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. 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 for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A 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 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 /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> Okb U42 000 i - <br /> e1U200a ' <br />