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--OM3/2005 15:17 FAX 209 948002 <br /> V IM002/002 <br /> RO E D GltV.-vJ:.vn.•:u• <br /> SAN JOAQTTiN Comm ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> F F9 At ,, 91199 304 E Weber-Ave 3`d Floor Stockton,CA 95205 <br /> ENVIRONMENT H E 1469-3420 Fax: (209)464-0138 Web:www•cO.san joaquin.=US/ehd 4J� <br /> PERMIT/SERVICES pURLIC RECORDS RELEASE APPLICATION, <br /> APPUCAHT.- j(b$t•f� BUSIHESSIAGEENCCY:'- <br /> ADDRESS: <br /> PHONE: 4191_61(w- V314s, FACSIMILE: tg -oat �— <br /> TENTATNr APPOINTMFNT DATE:— 610S Time: 1a iS❑ <br /> (Please allow 10 b�lries.a days from date of appltcaEan submlttaQ <br /> © CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � <br /> D Deua6r M Use Only <br /> FILE ADDRESS <br /> UNIT <br /> e D Unit 1 0 <br /> V vSr a s� <br /> 4. svMH'R a n <br /> uyJ s' sroce - a 11t Unit 3 <br /> IAS, t ' 5?�e4 <br /> 4 <br /> v VJT11 3. Svcs a )J Llnd S <br /> te. SOeel <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES vn�t <br /> 9 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 19I-•SOLID WASTE FACILITY <br /> i OTHER CLEANUP SITE(NON{OP) 1-1 FOOD FACILITY ❑ SOLID WASTE VEHICLE .. <br /> ®• UNDERGROUND TANK(MONITORING(REMOVAL) ❑ DOG KENNEL MDA.IRY <br /> JE HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH 0-PKG TREATMENT PLANT <br /> 10 TIERED PERMITTED FACILrTY - ❑ MOTELIMOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> ❑ TATYOOIaODY PIERCING ❑ POOL/SPA 03 LAND USEAPPLICATIONSITES <br /> ❑ MEDICAL WASTE FACILnY d 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 contirrned <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 /> 1 A file that is actively being worked on by EHD staff may not be immediately available for review. A ne• <br /> application may he 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 revie' <br /> 5. `TENTATIVE appointment dates must be confirmed with EHD Staff. <br /> 6. Applications received after 3:00 pm Will.be processed the nextbusiness day. <br /> 4.C'.ONF�,F2M�D.`APPOINTIVI.�N:, , •`CINE .•� �;3: .• �a�id'a?K.'. • r . <br /> NSI, l4�Et1. ' -:`;;-'PHONE • FAX":.`•;'''[;=.?-��iNFCIAL:S . ' :z:' <br /> REVIEWED ,• YES NO REVIEW DAT&. <br /> ' CMII88-0!-088 • <br />