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EHD LOG NUMBER <br /> -DATE FtEC1iVED , �✓ SAN JoA4UIN COUNTY. <br /> AEC ENVIRONMENTAL HEALTH DEPARTMENT <br /> SEP 2 9 2004 - 304 E Weber Ave P Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:*ww.co.san-joaquin.caus/ehd <br /> ENViRONiv'IE611 HENCTH <br /> PERMlT/SERVECES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_, c 4/10 ��5. BUSINESSIAGENCY: Fr- <br /> ADDRESS: GUt I /lam S/�S'� �� / y� <br /> s <br /> PHONE:� /—�b� FACSIMILE: 2 <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 "�t f <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I. sseet ❑ Unit 1 <br /> CRY <br /> 2- Sheet <br /> s. sheet ❑ Unit 2 <br /> 4. Streetcity <br /> s. sheet ❑ Unit 3 <br /> aty <br /> 6. Street <br /> 7. street Unit 4 <br /> !. sweet <br /> CW <br /> 9- Street ❑ Unit 5 <br /> io. 36" CRY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 0 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITY <br /> 0 OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> 0 UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> O HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 0 PUMPER TRUCKfYARD/CHEM TOILETS <br /> O POOLfSPA ZUMIND USE, T10N SITES <br /> O TATTOO/BODY PIERCING <br /> O (PLEASE MEDICAL WASTE FACILITY JR OTHER 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(2091464-0138 or mail to the <br /> address Indicated above. <br /> 2. EHD wilt 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 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 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 be reorganized by EHD staff at the expense <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. <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 /> N <br /> CQTYFIRMED AP-9 141E <br /> NT DATE <br /> TIME <br /> SATE CQNF1ftMl:DPHONE'-"' FAX" dKtT��►i-S �_ <br /> ... <br /> R _ <br /> iV1EYYED YDS N.O RM DATE: :''_ <br /> twtoo3 . <br />