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LyJutj <br /> EHD LOG NUMBER <br /> D <br /> :V��,'1 D � SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> MAR O 5 2004 304 E Weber Ave 31"Floor Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-0138 Web:y,ww.co.san-joaquin.ca,us/ehd <br /> EWRONMENT HEALTH <br /> PERMITISEMCES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: <br /> Y I BUSINESWAGENCY: <br /> ADDRESS: gb1� � � <br /> FACSIMILE: <br /> PHONE: <br /> TENTATIVE*APPO{NTMENT DATE: Time: ^ <br /> ��� <br /> (Please allow 10 business ays from date of app ice submlttal) )' R '� ��- <br /> ❑ CHECK BOX TO EXPEDITE REQUESTf$93.00 FEE—R EST PROCESSED IN 3 BUSINESS DAYS <br /> DATE <br /> SIGNATURE OF APPLICANT <br /> Department Use Only <br /> UNIT <br /> FILE ADDRESS <br /> �. Street <br /> raltyv Unit 1 <br /> 11 G <br /> 2. Street l <br /> a <br /> Unit <br /> 3. sweet uj aLl2 ? .� /ICt >{/�,'!1 91. <br /> +� <br /> 4. Street <br /> Unit 3 <br /> s. steer <br /> 6• Sir '7-1 2- <br /> arn, Unit 4 <br /> �. Street <br /> c� <br /> 0. s"'" ❑ Unit 5 <br /> 9. street <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> U ❑ Da,KENNEL <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT SOLID WASTE FACILITY <br /> THER CLEANUP SITE(NON-LOP) <br /> E3FOOD FACILITY �I SOLID WASTE VEHICLE <br /> ❑ DAIRY <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑ CHICKEN RANCH DAIRY <br /> TREATMENT PLANT <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL ❑ PUMPER TRUCKlYARD/CHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOLfSPA LAND USE APPLICATION SITES <br /> ❑ T MEDICAL WASTEODY <br /> PIERCING TE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> C3 MEDICAL <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)484-0138 or mail to the <br /> address Indicated HD above. ointment for review will be confirmed <br /> 2. Ewill notify theapapplicant if any EHD files exist. An app <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 /> rked on by EHD staff may not be immediately available for review. A nev <br /> 3. A file that is actively being wo <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 expens( <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to reviev <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 <br /> PHONE. . FAX 1N1TIALS <br /> REVIEWED YES NO REVIEW DATE <br /> EMD 46-02-008 <br /> 616(2003 <br />