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Sep 02 05 09: 34a pirM`-, 408---,-,3-1224 p. 1 <br /> U <br /> SAN JOAQUIN COt1N7Y EHD LOG NUMBER <br /> SEP _ 2 2005 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> ENVIRONMENT HalTV68-3420 Fax: (209)464-0138 Web: www.co.san-joaquin.cams/ohd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLTCAMN <br /> APPLICANT: Ver i-'f 1 BUfSIINESSIAGENCY: <br /> 3 <br /> ADDRESS: 1 Co M U !� c"-L To CA 9 <br /> PHONE: FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: �[ <br /> (Please allow 10 husin"s days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93 00�EE-REQUEST PROCESSED IN 3 BUSINESS DAYS d <br /> SIGNATURE OF APPLICANT oj"%�Og pw%, DATE -l BLESr� <br /> -- <br /> \�/ e, 1� Q t L A<- Department Use OnIV <br /> FILE ADDRESSUNIT <br /> street ;c u El Unit 1 <br /> & street f Unit 2 <br /> A. skeet 1 :fMG a lr`' <br /> 5. street _ U,nit 3 j!� <br /> l <br /> e. Sreet 3 r t G ct✓ �� , ., <br /> T. sued Advlf� Knit-4 <br /> S. StMt 161 otw _ <br /> 9. Stteel <br /> [] Unit S <br /> 19, street <br /> ENVIRONMENTAL HEALTH DEPARTMENT.FILES <br /> .s7 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FAC ILrrY <br /> -M-OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> -.0-UNDERGROUND TANK(MONITORING11 EMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> ,"AZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> 0 TIERED PERMITTED FACILITY ❑ MOTELIHOTEL ❑ PUMPER TRUCKrYAR.D1CHEM TOILETS <br /> ❑ TATTOOIBODY PIERCING ❑ POOLISPA M LAND USE APPLICATION SITES <br /> Q 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 checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 464-0138 or mail to the <br /> address indicated above. I <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 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 deposit prior to review. <br /> 3. *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm will be processed the next business day. <br /> CONFIRMED APPOINTMENT DATE TIME <br /> DATE CONFIRMED PRONE FAX INITIALS <br /> REVIEWED YES NO REVIEW DATE <br /> ettD 4M2-DOG <br /> era,�oaa <br />