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13415/2005 16:55 FAX x002/002 <br /> DAT((EE�RECENED SAN JOAQUIN COUNTY <br /> W �1 l�LuJ ENti IRON ENTAL HE.ALx&DEPARVIIIN'T' A <br /> 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> NOV 1 6 2( §) 468-3420 Fax: (209) 464-0138 Web:w w•co•sari]Ga9uiri ca-usehd <br /> ENVIRONMENT HEALTH ]? TBLXC RECORDS RELEASE AYPLXCAllbN <br /> PERMIT SERVI <br /> APPLICANT: O hm BUSWESSIAGENCY: <br /> ADDRESS: -4 E Tl.�• . <br /> L( r FACSIMILE: A <br /> PHONE ]', "" � <br /> TENTATfVE'APPOINTMENT RATE Z <br /> (Please allow 10 business days from data of applicaden suhmiftal( ti71iG0S tL^d <br /> CHECK eOx TO EXPEDITE REQUEST S93.00 FEE-REQUEST REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> DATE - L I� <br /> SIGNATURE OF APPLICANT Dacajrl+ent U�0* <br /> UNI <br /> FILE ADDRESS <br /> [3 Unit 1 <br /> �c cl IC 3 i F Unit 2 V. <br /> I ,i- tr L Unita far" <br /> A � �. swa Q�t" I 12(9F U <br /> Rd y� S. sed I Z �j F [3 Unit 5 <br /> a <br /> ,a. saw ENVIRONMENTAL HEALTH HEALTH DEPARTMENT FILES <br /> OP O HOUSING ABATEMENT .sol WASTE FACILITY <br /> UNDERGROUND TANK(USS CLEANUP SITE(L ) ❑ FOOD FACILITYABA7 ❑ SOLID WASTE VEHICLE <br /> OTHER GLFJUIUP SITE(NON-LOP) ❑ DOG KENNEL ®•DAIRY <br /> � UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ CHICKEN RPNCH a-Pi TREATMENT PLANT <br /> ffi I-1AZARDOl1S WASTE GENERATO0. ❑ MOTELIHOTEL ❑ PUMPER TRUCK/YARDICHEM TOILETS <br /> ❑ TIERED PERMITTED FACILITY ❑ POOVSPA Ca LAND USE APPLICAMON SITES <br /> ❑ TATTOOIeODY PIERCING Q OTHER(PLEASE SPECIFY] <br /> In MEDICAL-WASTE FACILITY <br /> 1. Ust up to ten addresses in the space above. Select the typa(s) of files from the list aboya by checking <br /> - the appropriate box(es). At least one file type MUST he selected. Fax to(2091 464-0138 or mail to the <br /> address indicated above. <br /> Z• EHD will notify the applicant if any EHD files exist An appointment for review will be con <br /> f les <br /> approximately rive business days but no Inter than ten (10) days after receipt of app <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 EHO staff may not be immediately available for review. Ane <br /> application may he submitted when the File is available. <br /> q, Any file not returned in the same condition as released will be reorganized by EHD staff at the expense <br /> Df the a noapplt retu Future file reviews by the same applicant may require a$93.00 deposit prior to review. <br /> S. 'TENTATIVE appointment dates must be confirmed with EHD staff. <br /> G. Applications received after 3:00 pm wilt be processed the next business day <br /> -=-`TIME " ?siz_•'s'.i:ir•i <br /> 5'..: <br /> .CbNF.:IR,,,M6Q`A>?:Pa1N71N�1dTTfF7E ' <br /> .,.5' FAX':_.'•:7" i„1NF lALs ' .�.::•F:.. : <br /> :WITE7 CPNFIRfAEp, <br /> REVIEWED YES NO REVIEW DATE' <br /> 7 <br />