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U3/I//201:10 1b:b8 2U93b94228 NEIL ANDERSON ENVIRO <br /> EHD LOG N: 5R <br /> IL( f`I sArr.roAQuzN COUNTY <br /> ]ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2005 304 F Weber Ave 3r1 Floor Stockton, CA 95205 r f <br /> ENVIRONMENT HEALTIi <br /> (209)465-3420 Fax: (209)464-0138 Web: vnvw.co.sanjoaquin.ca,us., <br /> PERMIT/SERVECE�S' PUBLIC RECORDS RELEASE APPLICATI01 _ <br /> APPLICANT: In '��.A S Q �L1�I(Y BUSINESSIAGENCY: A5::�� > <br /> ADDRESS: '"Ina ^7., V�,.B.b l�a,TI Ln aRe ) <br /> PHONE: a�-�- c (OfI ' t)�t� t FACSIMILE: C�n <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submitODATE <br /> CHECK BOX To EXPEDITE REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DSIGNATURE OF APPLICANT �� �a A Tvt <br /> Department Use On <br /> FILE ADDRESS UNIT <br /> 1. sveRl lir , C7 Unit 1 <br /> x. Slreei �n{'�'yn I — <br /> 7, eVeel "` /35 a i 1 L 1 Unit 2 <br /> e. Sl•. <br /> e�y CI. a� _ I3gcR ,., <br /> s, so-R,.l <br /> T. Slreei � . A1�J99 fw <br /> Unit 3 <br /> s. Imel F ✓ � <br /> / <br /> �Unit4 <br /> at 5 <br /> e. street .__._'�L '�L �t�(`-�li�J�a'^uy 0 t't T_ ❑ Unit 5 <br /> to. Slreei CI <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 7K UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 11 SOLID WASTE FACILITY <br /> 1,OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> -93, UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> JL HA7AR000S WASTE GENERATOR ❑ CHICKEN RANCH 0 PKG TREATMENT PLANT <br /> *TIERED PERMITTED FACILITY ❑ MOTEUHOTEL ❑ PUMPER TRUCK/YARD/CHEM TOILI <br /> 0 TATTOOIBODY PIERCING 0 POOLISPA ❑ LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List up to ten addresses in the space above. Select the type(s) of files from the list above by checi ) <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2 9)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. 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 expi a . <br /> of the applicant. Future file reviews by the same applicant may require a $93.00 deposit prior to re, Y. <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 /> FMII ARJ10J111 f. <br />