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frh� �J V LJJ SAN JOAQUIN COUNTY 41 FAD LOG NUMLR <br /> EN'VI iONMENTAL HL'ALTH DEVA.RTXENT <br /> j UN 5 2006 304304 E Weber Ave P Floor Stockton, CA 95205 <br /> ENVIRONMENT(�?XtM -3420 Fax, (209) 464-0138 Web: www.co.san joaquin.ca.us/chd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> � ` �-b ,euslNEssrAGENcY:.Al-q { d -t _c <br /> AI}CRESS. I <br /> FHfaAJE: FACSIMILE; r7 <br /> TENTATIVE*APPOINTMENT DATE. WE— —Time: <br /> (Please allow 10 business days from date of applicatlon subinittal) <br /> CHECK 130 TO EXPED)TE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS _ <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Odd <br /> _ FILE ADDRESS IT-. Ow <br /> Slri l 6sa -r, Vic R&. Z a� p ❑ ��lit 1 <br /> city U-0 1-1 <br /> 3. Slrt.t Cs G `W&Z <br /> �/ <br /> �-` L", Unit 2 � t <br /> 4. S,reei (P C. C 9 ' 1�1� cwy' _ &,- �r ✓�`y//t7 J <br /> 5, Slrcel ., "1 � 21 - *Pie Unit� <br /> z. Slrr+et _ c°a���`-�l , E ff w -- ca Urit 4- <br /> 8. Steel . Civ.. ._� f -^ ... ❑ Unit 5 <br /> F <br /> L3ENVIRONMENTAL HEALTH DEPARTMENT FILES R L: <br /> "IA UNDERGROUND TX14K(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT CI SOLID 11VAkS7—E FACILr1' <br /> OTHER CLEANUP SITE(MON-LOP) 0 FOOD FACILITY Cl SOLID WASTE VEHICLE <br /> UNUFMQROUND TANK(1MONrTORINGIREMOVAL) 0 DOG KENNEL L-I DAIRY <br /> )Zl HAZARDOUS WASTE GENERATOR a CHICKEN RANCH Cl PKG TfiEATNEIff PLANT <br /> A TIERED PERMITTED FACILITY Q MOTEL/HOTEL CI PUMPER MCKIYARPICHE=M TOILETS <br /> 0 TA1T001130PY PIERCING EI POOIJSPA 0 LAND UM APPLICATION SITES <br /> C7 MEDICAL.WASTE FACILITY ❑ MER(PLEASE SPECIE <br /> 1, List Lip to ten addresses in the space above. Select the types) of files from the list aboye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to.(2091 454--0138 or mail to the <br /> addross 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 (11)) 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 Eli❑ 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 will be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$89.00 deposit prior to review, <br /> 5, *TENTATIVE appointment dates must be confirmed with EMD staff. <br /> 6. Applications received after 3:00 pm will be processed the next businoss day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PHONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE a <br /> CND 46-u2.066 <br /> EJSr h}3 ' <br />