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tl � SAN JOA.QU N COUNTY *4 END too NUME;EP. <br /> ��UI <br /> ENVIRON ZNTAL HXALTH DEPARTMENT <br /> MAR 13 2006 304 E Weber Ave Yd Floor Stockton, CA 95205 3 <br /> (209) 468-3420 Fax: (209)4640138 Web: www.co.san joaquin.ca us/ehd <br /> EWIRONMENT HEALTH <br /> PERMiT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 8USiNE891AQENCY: /�J� VS�1 ✓ p fp,E <br /> ADDRESS: <br /> PHONE: 3M FACSIMILE:_ // O '1 3ilt�- L122 <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please allow 10 busineas days from data of applIcatlon submittal) <br /> CHECK 80X TO EXPEDITE REQUEST 193.40 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE.OF APPLICANT DATE <br /> Department Un Only <br /> FiLE ADDRESS UNIT <br /> ,. t1d COY � �❑ Unit 1 <br /> z. /� <br /> ff <br /> 9. } CIA G ❑ Unit 2 <br /> 4 StW <br /> 3 <br /> 5. $Ind CRY X Unit 3 /' <br /> 6. 81Re1 <br /> 1' vd <br /> 9 Met <br /> Q. CRY ❑ Unit 5 <br /> +o <br /> ENVIRONMENTAL HEALTH 101;PARTMENT FILES <br /> ti'UNOERGROUND TANK(US-1)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLiD WASTE FACILITY <br /> OTHER CLEANUP SiTE(NON-LOP) 0 FOOD FACILITY d SOLiD WASTE VEHiCLE <br /> UNDERGROUND TANK(MONITORiNO/REMOVAL) ❑ DOG KENNEL to 13AiRY <br /> i�jHA7�4RDOUS WASTE t3EAtERATOR 0 CHICKEN RANCH 13 PKG TREATMENT PLANT <br /> (� TIERED PERMITTED FACILITY ❑ MOTELiHOTEI. 0 PUMPER TRUCKiYARDiCHEM TOILETS <br /> O POoLrSPA 0 LAND Use APPLICATION SiTES <br /> ❑ TATTOOL WASooy PIERCINGFACILITY <br /> 13 OTHER(PLEASE SPECIFY) <br /> 0 MEDICALWASTE FACILITY <br /> 1. List up to tan addresses In the space above. Select the type(s)of files from the list'aboys ley checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to MS)464-0138 or mail Iq the <br /> address indicated above-, <br /> 2. EW- 0 will notify the applicant If any EHD files exist. An appointment for review will be confirmed <br /> approximately five business days but no tater 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 expense <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposl:prior to review. <br /> 5. "TENTATIVE appointment dates must be confirmed with END staff. <br /> 5. 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 /> REVIEWED YES NO REVIEW DATE <br /> HR As.Oi OR <br /> ararzoai <br />