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FROM : Ground Zero Analys' PHONE NO. : 209 838 9883V Nov. 29 2005 10:19AM P1 <br /> �'��� ��� SAN JoAQu><N COUNTY EHO LOG NUMBER <br /> ENVIRONMENTAL HEALTIi DEPARTMENT f\ <br /> NOV 2 q 4`005 304 E Weber Ave 3`d Floor Stockton,CA 95205 U <br /> (209)468-3420 Fag: (209)464-0138 Web:www.co.san joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; 1 �JBUSINESSIAGENCY: <br /> ADDRESS: !�y/\� p, �S �} p <br /> PHONEQC—) <br /> TENTATIVE'APPOINTMENT DATE:'-!)Q-P /YVLL4 Time: "O <br /> (Please allow 10 business days from date of application submittal) <br /> In CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE <br /> �—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �W --.� - DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> 1. suet 3Unit 1 <br /> z s+M9t 3�5 <br /> s. ab=et ❑ Unit 2 <br /> 4. sweet o <br /> s. sw.t chy � Unit 3 <br /> 6. •Sv"t <br /> T. sheet Unit 4 <br /> a street <br /> s. &idet ON Unit 5 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 17 SOLID WASTE FACILITY <br /> �Ut� <br /> Ig "M CLEANUP SrrE(NON-LOP) O FOOD FACILITY U SOLID WASTE VEHICLE <br /> DERGROUND YANK(MONI TORINGIREMOVAL) 0 DOG KENNEL Q DAIRY <br /> IW'HAZARDOUS WASTE GENERATOR Q CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY MOTELfHOTEL [7 PUMPER TRUCK/YARDIGIRFTt TOILETS <br /> G TATT601BODY PIERCING O OMPA 0 LAND USE AP LIC TION S <br /> Cl MEDICAL WASTE FACILITY �THER(PLEASE SPECT <br /> 1. Ok— <br /> List up to ten addresses in the space above. Select the type(s)of files from the list above by checidng <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 EHO 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 morgan'Ized by EHD staff at the expense <br /> of the applicant. Future fila reviews by the same applicant may require a$93.00 deposit prior to review. <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 PHONE FAX INITIALS <br /> REVIEViED YES NO REVIEW DATE <br /> IM46-M-00 <br /> rarsao� <br />