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EHD LOG NUMBER <br /> DATE REV WED SAN JOAQUIN COUNTY <br /> I Ei NytRONm ENTAL HEALTH DEPARTMENT I <br /> FEB 0 9 7005 304 E Weber Ave 3`4 Floor Stockton, CA 95205 <br /> ( 99� ��ft?�}20 Fax: (209) 464=0138 Web: wwWco•saIIJOaquin.ca.us/ehd <br /> Er�viRor��xL <br /> PERMi\T'SEPMCE�S PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: J 'e' h w� Y" BUSINESSSIA�GENCY: <br /> ADDRESS: O \ _(IS S -3 S <br /> q 'L2 2'ts"7 <br /> PHONL?-�R 7+�- FACSIMILE: <br /> TENTATIVE' APPOINTMENT DATE: �\3` � <br /> �y (piwse allow 10 buelnasd days Irom data Of nppllwtlon *ubmfaal) <br /> I-� CHECK BOX TO EXPEDITE REQUEST . $IMAO FEE W REQUEST PROCESSED IN a BUSINESS DAYS Q 1� <br /> SIGNATURE OF APPLICANT N mv<� DATE l <br /> Danalti Use Onlr <br /> UNIT <br /> FILE ADDRESS <br /> '101Lw a 51ack � t I � t [1 Unit 1 <br /> a. n� <br /> S 1 O vK a r, `t''r k <br /> & s� CAWp Unit 2 <br /> �. 6 <br /> o. s4ee1 a UB@ 3 <br /> e. sure G00, <br /> t e ❑ Unit 4 <br /> e. swa a <br /> a sfroel ❑ Unit 5 <br /> 10. S G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROUND TANK (UST) CLEANUP BITE (LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> OTHER CLEANUP SITE (NOWLOP) 0 FOOD FACILITY O SOLID WASTE VEHICLE <br /> UNDnKGROUND TANK (MONITORINOIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> 0 HAZARDOUS WASTE GENERATOR EI CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTEUHOTF% 0 PUMPER TRUCKIYAROICHEM TOILETS <br /> 0 TATt00toopf PIERCING 0 POOLISPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY O OTHER (PLEASE SPECIFY <br /> I . List up to ten addresses In the space above. Select the types) Of files from the list above by checking <br /> the appropriate box(ea). At least one file type MUST be selected. Fax to 46"1136 or Mail tQ the <br /> address indicated above. <br /> y, EHD will notify the applicant if any EHO 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 /> 31 A file that Is actively being worked Gn 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 ba reorganized <br /> by EHD deposit prior t at the review. <br /> nse <br /> of the applicant. Future file reviews by the same applicant may req BP a <br /> 0. "TENTATIVE appointment dates must be confirmed With EHD staff. <br /> 0. 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 /> Ell 1-000 <br />