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t EHD LOG NUMBER <br /> D� NTY fI�✓J �� SAN JOAQUIN COU `�j/ <br /> ENVIRONMENTAL HEAI,-rH DEPARTMENT <br /> JUL 2 7 QQ 304 E Weber Ave P Floor Stockton,CA 95205 <br /> �L09�468-3420 Fax: (209)464-0138 Web: www.co-san joaquin.ca.uslchd '493 <br /> ENVIRONMENT HEALTH <br /> PERMIUSERVICFS PUB�/L�IC RECORDS R LEASE kpPPLICATION <br /> APPLICANT; (La 4 L BUSINESSIAGENC(Y:�t F r-M 1 <br /> ADDRESS:p.�11 �IyHb Y✓ JLU Z-k'D (�Q.lht Cicck_ CA <br /> PHONE: C-!!/�) 27�'J�! FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: �6 <br /> (Please allow 10 business days from date o epPli tion su mittal) <br /> i <br /> II <br /> CHECK BOX TO EXPEDITE REQUEST 493.00JEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> ff '` 7 27 0 <br /> SIGNATURE OF APPLICANT A r(/t�G.l �i. _ DATE <br /> " DeDarhnent Use Only <br /> �l <br /> u'� �L� FILE ADDRESS !{ UNIT <br /> a[� C'n T-Y0.cV rL ! ]_r l" El Unit 1 <br /> swel 7500 1U i1t61Ian T,.r a�T <br /> o svee� _13111 W _II ib 51 rf ., cn. t,y `'- ! 'Y) E] Unit 2 <br /> nit 3 \ <br /> dGrl <br /> nit4 <br /> 9. ,•oami ,rte. ... <br /> i 15 <br /> 10. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -9 UNDERGROUND TANK(USTI CLEANUP SITE(LOP) O HOUSING ABATEMENT ii 0 SOLID WASTE FACILITY <br /> 1K OTHER CLEANUP SITE(NON-LOP) O FOOD FACILITY 0 SOLID WASTE VEHICLE <br /> )d UNDERGROUND TANK(MONITORINGIREMOVAL) E3 DOG KENNEL y 0 DAIRY <br /> ❑ HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY 0 MOTELIHOTEL 6 PUMPER TRUCKIYARDICHEM TOILETS <br /> O TATTOOfBODY PIERCING 0 POOUSPA II 0 LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> li <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. If <br /> 2. EMD 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 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. it <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 /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 5. Applications received after 3:00 pm will be processed the next business day. <br /> F <br /> MED APPOINTMENT DATE TIME <br /> NFIRMED PHONE FAX INITIALS <br /> D YES NO REVIEW DATE <br /> Ewo�aax.006 <br /> Y61MOJ <br /> Z7-'©`� �' �lCcat ;.�! c1�1 ����G�'�SLI•SC�/�'? I <br />