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ENVIROhS1ENTAL HEALTH PAGE 01 <br /> 0-F7}12 04__141 50� 4640138 tnU Lw Nuvnoat� <br /> )A R "-��V SAN JOAQI3INCOUNTY <br /> MAY 1 1 2004 ENVM0x1'1VIENTAL$EALrn1DE?ARTMMNC Ig/3 <br /> 304 E Weber Ave 3'd Floor Stockton,CA 95205 <br /> ENVIR0NMEr(Z*At*3420 Fax: (209)4.64-0138 Web:www.c0.san joag1Lin.ca ns/ehd <br /> PERiMIMSERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> PucANT: <br /> pSk13Us51N5E�SSIAGENCY: S FAIrMY4 TV.c <br /> / yp U7LrDREss: <br /> LPHONE: <br /> NO FACSIMILE: )3O- -76-600 <br /> TENTATPJV APPOINTMENT DATE:TP 1�iSC CE+(I INO �°SJfPci!✓rl<P —Toe: 8:oa <br /> (Please allow Ig btlsi,ass date frwu data of application submitlaq <br /> CHECK BOX TO EXPEDITE REOUES7.593.00 <br /> FEE-RE E57 PROCESSED IN 3 BUSINESS DAYSDATE <br /> SIGNATURE OF APPLICANT r `�°`- - <br /> prparfmcnt Use Only <br /> um <br /> FILE ADDRESS <br /> e} Un"1 <br /> to 15, wi W 5 bdr <br /> 5 <br /> k ti ❑ Unit 2 Q <br /> I S . S Unita <br /> e o <br /> e awed p Unit 4 <br /> 0. 9a d <br /> 9. Shed tx <br /> My <br /> 10. Sint <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ❑ HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> UNDERGROUND TANK(�7)CLEANUP SITE(LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑ DDG KENNEL C OASRY <br /> UNDERGROUND TANK(MONrrORINGIREMOVAL) 13 CHICKEN RANCH ❑ PKG iREA7MENT PLANT <br /> i HAZARDOUS WASTE GENERATOR P MOTELMOTEL ❑ PUMPER TRUCKMARDICH'E ITOaFTS <br /> ❑ 'nEREO PERMITTED FAC 'p pOOL19PA 0 LAND usE APPLICATION SITES <br /> ❑ TATTOOMODY PIERCING P OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACiLtt'1e <br /> 1. List up to ten addresses(n the space htype(s)above. Select the yes)of files from the list above by checking <br /> the appropriate box(es). At toast one file type MUST be.selected. Fax to 209 464-0138 or mail to the <br /> address indicated above._ y ointment for review will be confirmed <br /> 2- EHD will notify the applicant if an EHD fifes exist An app <br /> approximately five business days but no later than ten(10)days aoftetrmr encs should pbo schoduledfl05 <br /> will be hotd for a maximum of five bUsiness da for review. App <br /> accordingly. being of be immediately available for review. A new <br /> 3. A file that <br /> i majiveiy b submitted when the file avail ble n <br /> app' Y will be <br /> 4. Any file not returned in the Same condition as <br /> applicant may require ra$93.00nepostaff at the expense <br /> s prior to review, <br /> of the applicant Future file reviews by <br /> tREVIEWFD <br /> 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> plications received after 3:00 pm will be processed the next business day. <br /> TIME:Ep APPO{NTMENT DATEPHONE . FAX INITIA!SIRMED REVIEVN DATE <br /> YES NO <br /> EHo as.r•Lo6_ _ <br /> en�nnn <br /> 0/10 39Vd dI-tlO ON snivais 90099L90E9 SV:VT V00L/11/90 <br />