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b3/1!/'LbbS lb:bb ZUV3b94228 <br /> NEIL ANDERSON ENVIRO 1 U <br /> C. <br /> EHD LOG N!, =R <br /> D SAN JOAQUiN Cava r <br /> &+NVIRONMENTAL STEALTH DEPARrNUNT <br /> '684005 3041✓Weber Ave 3"Floor Stockton, CA 95205 <br /> (209)468-3420 Fax: (209) 464-0138 Web: w-vvw.co.san-joaquin.ca.us/eh <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: `�� i� ��'r BUSINESSIAGE`NCY: Q 4\n. t1Y\ E)/'�^ ` <br /> ADDRESS , Wil' • �5 <br /> PHONE: � 1 FACSIMILE: _� "- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use On <br /> - FILE ADDRESS ��.�Q <br /> UNIT <br /> 1. Strrrl 1 city ""T { ..�r ❑ Unit rl <br /> 2. Slreel g C <br /> 2, Stri Lir o� I1715 P 1 1 1 Unit 2 <br /> ,. SIrve1 cly. <br /> 't <br /> 5. Slrrrl r .�- �!7... Gty�-^�-��e— r:.. Unit 3 <br /> 00 <br /> - OOOW <br /> 6. SVeel [..��G Cly r <br /> 7. street la- S • 11 1� vz �Unit 4 <br /> Stregi <br /> A. <br /> 9. street _ <br /> u�Fa �' ' Q Unit.r7 <br /> 10. Sheet CI <br /> ENVIRONMENTAL;HEALTH DEPARTMENT FILES <br /> 14 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 17 HOUSING ABATEMENT d SOLID WASTE FACILITY <br /> V�OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY Q SOLID WASTE VEHIC LF <br /> I& UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL O DAIRY <br /> I •HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> *TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILE <br /> ❑ TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WAST=FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type($)of files from the list above by checl ) <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to t <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 fi <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 v <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 expo a <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to rel Y. <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 /> can A")nnf. <br />