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oil 1!/1bE75 lb:b8 10936y4118 <br /> NEIL ANDERSON ENVIRO NAUE Ul/l7 <br /> EHD LOG N*� =R <br /> SAN.TOAQUIN (-OUN'IY <br /> (� ENVIRONME,NTA.L HEALTH DEPARTMENT <br /> 2��5 3041:Weber Ave P Floor Stockton, CA 95205 <br /> (209) 468-3420 fax: (209)464-0138 Web: www.co.san-joaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES' PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:` �� � � IJ.�Csr BUSINESS/AG ENCY:—` <br /> ADDRESS- °IOa. TY-\A—LLSiy <br /> PHONE: c� '_��=. �) � F1ACSIMILE•` <br /> TENTATIVE"APPOINTMENT DATE: e= <br /> (Please allow 10 business days f a plication submittal) <br /> -516 <br /> CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use On <br /> FILE ADDRESS UNIT <br /> N jr <br /> N 1. Slrrrl 716A Unit 1 ' <br /> �S 2. Slreel <br /> D��*t <br /> I <br /> -1-11 <br /> - I '1"A 1W" I lS V 6vee NQ Lity Rv F 2°4 El Unit 2 <br /> v h v\5 I �. J�mFI cit <br /> slmrt ,�- �tn�- fir— Unit 3 <br /> ,r 8. Street ,`C, <br /> ee""Unit 4 <br /> vreglc�G�t <br /> street .� _� R1,�� 1T•�ItY ❑ Unit 5 <br /> Ia. Street a <br /> ty <br /> I ENTAL HEALTH DEPARTMENT FILES <br /> C Q� <br /> FACILITY <br /> JR UNDERGROUND N (UST)CLEANUP SITE(LOP HOUSING ABATEMENT ❑ SOLID WASTE FACT <br /> OTHER CLEANUP SITE(NON-LOP) FACILITY CJ SOLID WASTE VEHICLE <br /> -FL UNDERGROUND TANK(MONITORII�I�pm((tV�Q ❑ DOG KENNEL D DAIRY <br /> �tl HA7AF2b0US WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑ MOTEL/HOTEL l0 PUMPER TRUCK/YARD/CHEM TOILE <br /> ❑ TATTOOIgODY PIERCING ❑ POOLISPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WAST=FACILITY Cl OTHER(PLEASE SPECIFIC <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checi 1 <br /> the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to t <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 fi <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile that is actively being worked on by EHD staff may not be immediately available for review. A v <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 expE <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to ret V. <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 /> REVIEWED YES NO REVIEW DATE <br /> On.t n.AKfinR <br />