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DATE RECEIVED V SAN JOAQUINCOUNTY � <br /> Ull LS '. < < ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave P Floor Stockton, <br /> $EP 2 2 2 CA 95205 <br /> 8209)468-3420 Fax: (209)464-0138 Web:www.cosan-joaquin-Ca-US/ehd oa5 <br /> ENMRO tL_ti^ AAJH <br /> PERM ;;;,^VI CES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT, BUSINESSIAGENCY• <br /> ADDRESS- •Ir ' <br /> PHONE: — (MILE: <br /> 5 � �i ,weds by <br /> TENTATIVE'APPOINTMENT DATE: Time: moltd <br /> (Please allow 10 business days from date of application submittal) AA001'N� <br /> /f <br /> HECK BOX TO EXPEDITE REQUES 3.0 EE—REQUEST MESSEPD IN3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 4 DATE . t <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> sa..e Cft�aG2 ❑ Unit 1 <br /> z �_ -!� <br /> a se.� ❑ Unit 2 <br /> Cft <br /> <. saee� oty <br /> s. sweet 3 <br /> s. areal <br /> 6. steel <br /> s. sties <br /> Ck <br /> 9. sac« ❑ Unit 5 <br /> to. street <br /> s <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ,W40W RGROUND TANK(UST)CLEANUP SITE(LOP)_ 3 �MENT 0 SOLID WASTE <br /> pL OTHER CLEANUP SITE(NON.LOP) O SOLID WASTEHICLE <br /> )i -UNDERGROUND TANK(MONRORINGIREMOVAL) 13 DOG KENNEL 0 DAIRY <br /> jtS WASTE GENERATOR C3 CHICKEN RANCH 17 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY O MOTELIHOTEL 13 PUMPER TRUCKIYARD/CHEM TOILETS <br /> O TATTOOIBODY PIERCING O POOUSPA O LAND USE APPLICATION SITES <br /> L3 MEDICAL.WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the-types)of files from the list aboye 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. <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 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 exp2pse ' <br /> of the applicant. Future file reviews by the same applicant may require.a$93.00 deposit p ew. <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 /> QNFI.RMED 4t PP.9 NTMSNT DATE .r' TIME <br /> ,} FAX <br /> RiVIED <br /> ;SA'1'�CON91 : <br /> ONE <br /> 1'tV1EYYED YES NO ''' ' REVIEW DATE: <br />