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aAJ.4 . llA ►JUIN t�VUA`�JL X <br /> I..• , 2 1 2005 EL-' DPAR`" NT <br /> 174 L Weber Ave 3'Floor Stockton,C,A,9M3 <br /> ENVIRONMENT H 4}i468-3420 Fax: (209)464-0138 Web:www-cO.=joaquin.ca.us/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE"PLICATION <br /> APPLICANT: A6UG t..Q BUSIMMIAGENCY: <br /> ADDRESS: D S <br /> 0" <br /> PHONE:- FACSIMILE: " Am <br /> TENTATIVE"APPOINTMENT DATE: Tines: <br /> (Plwse&POW 10 bUSIM s days Mont data of application submittal) <br /> CHECK BOX Tp EXPEDITE REQUiaST->j03.Ob�H., QUEST PROCESSED IN 31,USINESB DANS <br /> /SIGNATURE OF APPLICANT DATE 7-11 O <br /> Department Use Q* <br /> >rE.E ADDRBss UNIT <br /> 1. mod15 $ s. <br /> 2. aw2 1 C . r Q Unit 1 <br /> s. CRY <br /> 4' <br /> ' <br /> ;Unit4 <br /> a. <br /> [� Unk b <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) O HOUSING ABATEMENT O SOLID WASTE FACILITY <br /> OTHER CLEANUP SiTE(NOH4AP) O FOOD FACILITY O SO411)WASTE VEHICL,B <br /> U10MGROtNiD YANK(MOMTORINGMEMOVAL) O DOG KENNEL O DAIRY <br /> HAZARDOUS WASTE GENERATOR O CHICKEN RANCH O PKG TREATMENT PLANT <br /> TIERED PERMITTED rACILI Y O MO'1`EVHOTEL 0 PumpaR TRUciVYARDICHEM To LETS <br /> O TATTOO(SOOY PIERCING O POOL/SPA O LAND USE APPLICATION SITES <br /> M MEDICAL WASTE FACILITY 13 OTHER(PLEASE SPECI ni <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking <br /> the appropriate boX(eS). At least one file type MUST be selected. lax to(209)46"138 Qr Mail to 1110 <br /> addles indiealaabove. <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 appilcation. The flies <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. A file that Wactively being worked on by EHD staff may not be(mmedlately 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 ND 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. 'TENTATWE 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 iNMALS <br /> REVIEWED YES NO REVIEW DATE <br />