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/2005 11:05 FAX 209 9; 621 Q002 <br /> . (J ::- <br /> °AR9 Il 'v �, �� SANJOAQUU Cain <br /> EN M0NMMNTAL HEALTH 1)EPAkf YTENT <br /> 304 E Weber-Ave 3`d Floor Stockton, CA 95205 <br /> ENVIrr",CINNir-Nl(RQ9�:iW$-3420 Fax-, (209)464-0138 Web:,,vwrv.co_san joaquin.Ca..us/ehd <br /> PERN IT,/SCES <br /> PUBLIC RECORDS RELEASE APPLICA.110ZY <br /> APPLICANT: I dr3CI� Vb L f @rUSINES�SIAGENCY: �l f <br /> ADDRESS:_ �Y - S /= // 1� I<9.Q — <br /> PHONE: 12JA vs—ItX5, - - FACSIMIL.E:ITENTATIVE*APPOINTMENT APPOINTMENT DATE <br /> (Please allow 10 titminess,clays from date of ap0Atiorn submittal} <br /> k' <br /> CHECK BOX TO E.XPEDiTE REQUEST--;9 .00 FEE-REQUEST PROCESSED N 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE Q <br /> ' [3epartrnent Usa Only <br /> FILE ADDRESS uNTr <br /> I. see Gly [) Unit 1 <br /> ;. Street /,� <br /> a- SVaeL Yr �' L,lnit 2 <br /> s. s ..Unit 3 <br /> T. sued D..Owunft <br /> 9 sweet ❑ Unit 5 <br /> to. Bred ;r <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES owl <br /> UNDERGROUND TANK(usT)CLEANUP srrE(LOP) ❑ HOUSING ABATEMENT E.SQLID WASTE FACILITY <br /> OTHER CLEANUP SITE(NOH4AP) ❑ FOOD FACILITY ❑ SQLID WASTE VEHICLE <br /> 0- UNDERGROUND TANK(M0NrrORIN(jlREmOVAL) ❑ DOG KP-NNEL l9L DAJRY y <br /> 0 HAZARDObS WASTE=GENERATOR ElCHICKEN PAr[CH 0-PKG TREATMENT PIANT <br /> 0 TIERED PERMMT-ED I±ACILrry CI MOTELlt-IaTEL ❑ PUMPER TRUCKNARDICHeM TOILETS <br /> ❑ 'TATCOQIE300Y PIERCING CI POOLISPA M LAND USE APPLICATION Srm.s <br /> ❑ MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY} <br /> List up to Gen.addresses in the space above. Select the type(s) of files from the list above by checking h <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 209 464-013a or mail to the <br /> address:indicated above_ 3,. <br /> 2_EHD will notify the apfrl(cnnt if any EHL) 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 ffve,business days for review, Appointments should be scheduled <br /> accordingly. <br /> 3. A file that is actively being worked on by EH» staff may not be immediately available for review. A nes <br /> applicatian may be submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHI7 staFF at the expenst <br /> of the applicant. Future file'reviews by the sante applicant may require A $93.00 deposit prior to rOviel <br /> S. TENTATIVE appointment dates must be confirmed with EHD staff. <br /> s. Applications received after 3;00 pm will be processed the next business day. <br /> • 1PR04Nl14lEIVTpATEi :r ,w..,. TIME; ; }. r'r. f <br /> h r:Y ... ♦ . <br /> Ll <br /> � 1' T - • fir-•.' '•Y.. .~ <br /> "OATE•C�ghi>=IRMEa, ' _ ; , �'"� �`P140F_ - FAX <br /> REVIEWED YES NO REVIEW MATE <br /> EHO 41.4240s <br /> r, nnn, 6 <br /> :Ig Ei <br />