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08/15/2005 16:09 8189790f- ''� JMK ENVIRONMENT -PAGE 01 <br /> E E'--'J em LOG Wur <br /> mm <br /> SAN JOAQUIN COUNTY <br /> Qilr ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2005 304 EAST WEBER AVENUE,THIRD FLOOR <br /> STOCKTON CA 95202 35 <br /> ENVIRONMENT HEALTH (zo9)465-3420 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT c f M 1 6 1330SINESSIAGENCY <br /> ADDRESS 17315 N. a 14L JLt'/1 s~ <br /> PHONE + r ` k_ .,—FACSIMILE 7 <br /> TENTATIVE*APPOINTMENT DATE / 6l d� TIME } Zvi _ <br /> (Please give I to 10 business days tram date of application submittal) <br /> •CHECK BOX TO EXPEDITE REQUE=22� <br /> CESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE ��'�� <br /> t tLC AtaDnGEE <br /> THIS SIDE E140 STAFF USE ONLY <br /> PROGRAM ELEMENTS UFAMUH <br /> LE <br /> ENVIRONMENTAL HEALTH DIVISION FILES <br /> >Ct UNDERGROUND TANK(Usti CLEANUP srE(LOP) D HOUSING ABATEMENT O SOLID WASTE F MY <br /> J*OTHER CLEANUP SITE(NON-LOP) tl FOOD FACILITY tl SOLID WASTE VEHICLE <br /> Me}}JJNDERGROUND TANK(MONITOR11401REMOVAL) CO DOG KMNNEL t7 DAIRY <br /> .HAZARDOUS WASTE GENERATOR O CHICKEN RAN GH C1 PKG TRJEATMENT PLANT <br /> tl TIERED PERMITTED FACILITY 0 MOTI.IHOTEL 0 PUMPER TRUCKIYAI�ICHEM TOILETS <br /> D TATTOO1800y PEIRCING 4 POOLISPA 17 1 ATtD USE APPLICATtOti SrrE9 <br /> M M EDIGAL WASTE wAUMMY O 0TH0R(PLtrASE SPECIFh _. . — <br /> files from <br /> ist above by <br /> 1. lIso Ap date up to ton addresses(�) At least one file HAUS? be selected.ace abOVO. Select the pf Fax t(09]4 14 "138 or mail 10 the <br /> _ address indicated above. <br /> x. EHD will notify the applicant If any ENO files exist. An appointment for review will be confirmed <br /> approximately fivra 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 fila that to actively being wnrkrd an by ENO staff may not be Immediately availabla for review. Anew <br /> application may be submitted when the file is available. <br /> 4. Any File not returned in the some condition as released will ba reorganized by 5HD staff of the expense <br /> of the applicant- Future file reviews by the same applicant may require a$89.00 deposit prior to review. <br /> S. *TENTATIVE appointment dates must be confirmed with END 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 tiVITIAt..s. <br /> REVIEWEE)- YES NO Re"Ew OATS <br /> Rio 4842-MV <br /> 2nW1Wa <br />