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04/10/2006 15:07 FAX Z001/001 <br /> �" 411v�vv i+vnwr•+ <br /> (��D[tA,�.T-,RREfCEI1V�ED Spay IOAQIJCtYCO>INTY <br /> IR1.1�\"'I'-�L v ED EN"VIRO v1YMNTAL HEALTH DEPARTNLELNT <br /> 304 E Weber:Ave"X d Floor Stockton, CA 95205 � l <br /> wYt 1 [UGb 209 468-3420 Fax: (209) 464-0139 Web: w•�rx.co.saa-joaquia.ca.us�ebd� 3 <br /> ENVIRL)NjM 0T HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE F Oi`i <br /> APPLICANT: C-_,T - - <br /> s�rt,c -7�J.> _ <br /> ADDRESS: Z-"� E . til J �.• �. <br /> PHONE: <br /> FACSIMILE: 0(0 <br /> TENTATIVE'APPOINTMENT DATE' <br /> (Please allow 10 titminess days from date of appllotion stxbm'Wrl <br /> En CHECK BOX TO EXPEDITE REQUEST-591�t.00 nFEE-REQUEST PROCESSED IN 0 BUSINESS DAYS <br /> �lxr�4'i l I� 1 DATE <br /> SIGNATURE OF APPLICANT �, „r,�,,,.,�____.. - Deparv,ent Use OF* <br /> UNIT <br /> FILE ADDRESS <br /> 3. <br /> �r4. <br /> y�Izs cG a <br /> TUM3rr1+116 El. a 4 5 <br /> to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> C' HOUSING ABATEMENT Q-sOLID WASTE FAGLrrY <br /> UNDERGROUND TANKNSTI CLEANUP SRL.(LOP) C' <br /> FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 21 OTHER CLEANUP 517E(NON-LOP) ❑ DOG KENNEL e9-DAIRY <br /> TY UNDERGROUND TANK(MONITORINGIREMOVALI O CHICKEN RANCH E-PKG TREATMENT PLANT <br /> A0, HAZARDOUS WASTE GENERATOR [IM KEEN TEL O PUMPER TRUCKlYALETS <br /> RDlGHEM TOI <br /> ❑ TIERED PERMITTED FACILITY O POOLISPA la LAND VS <br /> SE APPLICATION SrrE <br /> ❑ TATTOOMODY PIERCING p OTHER(PLEASE SPECIF()_•,.^.,,.„ <br /> D MEDICAL YfASTE FACILITY <br /> 1. List up to ten addresses in the space above. Select the type(s) of file. from the 115t above by checking <br /> . the appropriate box(es). At least one file type MUST be selected, Fox to 299 46d-01L 3A°r maims t°the <br /> address!ndlca[ed ahovc, y appointment for review will be confirmed <br /> y. EHD wlil notify the applicant d y EHObut <br /> n Files exist. t n pp <br /> approximately five business day.but n° W[M than ten (10) days alter receipt of application. The 04, <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. at the <br /> 4. Any file not returned in the same condition as releasedl be <br /> may reGuirezed by EHO a 593.0 deposit prior to P view. <br /> of the applicant. Future file reviews by the same app ' 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. J� <br /> rR <br /> ONFIRMElO,APPOINTENTET E <br /> ATE�OYFIFtMED <br /> FAXEJIEVJEp YES NO F?EVfEti^t DATE' w . <br />