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WED SAN JOAQVIN CONY EHO LOC Nf1M8ER <br /> ENvmoN I ENTAL HEALTH DEPARTMENT <br /> APR 2 9 20�024pg 304 E Weber-Ave 31"Floor Stockton,CA 95205 <br /> t:NViPUNMENT H�X[LI {468-3420 Fax: (209)464-0139 Web:www.co.san-joaquin.ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPUCANT:AWVAAA6k WhIve BUSINESSIAGENCY: ,� <br /> ADDRESS: IWN I r 1 L) <br /> PHONE: Z' FACSIMILE: �i 7 2. <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Pleaaa allow i0 buslnew days hvm date of appikaHon subminai) <br /> CHECK BOX TO EXPEDITE RE EST-$93. E—RE VEST PROCESSED IN 3 BUSINESS DAYS " S <br /> SIGNATURE OF APPLIC DATE %-A dy ph n(y yeti ' <br /> De <br /> p� l <br /> FILE- UNIT <br /> Cd I <br /> �.�� ~� 2- 6*6e� �(,� Unit 1 <br /> Grey a --sem w t Cl Unit 2 <br /> S. s,Bet a9 it 3 <br /> s. aeeec rn � I <br /> 7. Suvot <br /> a. Sheetcm <br /> I <br /> 9. Sheet - <br /> to. street ❑ Unit 5 ly <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> O UNDERGROUND TANK(UST)CLEANUP SITE(LOP) In HOUSING ABATEMENT © SOLID WASTE FACILITY <br /> pC OTHER CLEANUP SITE(NON-LOP) 11 FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> 13 UNDERGROUND TANK(MONITORING/REMOVAL) LI DOG KENNEL O DAIRY <br /> f�C HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PLANT <br /> ❑ TIERED PERMITTED FACILITY O F40TELIHOTEL O PUMPER TRUCKIYARDICHEM TOILM <br /> 0 TATTOOIBODY PIERCING ❑ PoobsPA O LAND USE APPLICATION sans <br /> ❑ MEDICAL WASTE FACILITY 11 OTHER(PLEASE SPECIFYL <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the fist above by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to 1209)49"13a or mail to the <br /> address indicated_above. <br /> 2. EHD will notify the applicant if any EHD flies 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 hell)for a maximum of five business days for review. Appointments should be scheduled I <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. Ally NO 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 depositprior 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 71ME <br /> DATE CONFIRMED RHONE FAX. INITIALS <br /> REVIEWED YES NO REVIEW DATE- <br /> UW"424W <br /> W=03 <br /> 000 T00 HOOSS 059TZL£9Zt %V3 WCT 17U VO/6Z/V6 <br />