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tl3/1//2k917b 1b:b8 2U93b94228 NEIL ANDENSUN ENVINU 1-H., .11V <br /> D 40EHD LOG N: ER <br /> ROWE <br /> SAN JOAQUiN COUNTY <br /> ENVIRONMENTAL HEALTH DEPA.R'1'MENT <br /> FY .41 1 u 2005 3041;Weber Ave 3rd Floor Stockton, CA 95205 <br /> (209) 468-3420 Fax: (209)464.0138 Web: www.co.sanjoaquin.ca.us/ehd <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES' PUBLIC RECORDS RELEASE APPLICATION — <br /> APPLICANT: I BUSINESSIAGENCY: <br /> ADDRESS: 'nIna SY�AttS+y: T1 I—oat C Pc �5� <br /> PHONE: a - ��-0 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittaq <br /> CHECK BOX TO FXPEOITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT � n7�Ya�a' A h't DATE <br /> p <br /> Department Use On <br /> FILE ADDRESS UNIT <br /> 1. alma h l r aly Yl/�Ot tn-� ., , ,1 ❑ Unit 1 <br /> 2. streetp �� 1 <br /> jX <br /> 1. Street !W LN ^ ( /J'!3�$�ja-hm 1 ,Unit 2 <br /> 1. SIrv.H cit M I:? •tl-'i 6 J. <br /> Unit 3 3� <br /> 5. sln;e9 <br /> e. SVeel �G CI r <br /> ,. street Unit 4 <br /> 1 <br /> e. Sir I <br /> 9. Sirt ..—. 45Jy-- �1��`�h Unit <br /> 10. Sire 1 G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> -K UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT ❑ 50LID WASTE FACILITY <br /> 4C OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY O SOLID WASTE VEHICLE <br /> It UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 1 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKIYARDIGHEM TOILI <br /> ❑ TATTOO/BODY PIERCING ❑ POOUSPA ❑ LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ 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 checl <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 fl <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 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 expo <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to to, 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 /> FYII.1 P.19f�f. -• . <br />