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08-14 2 <br />1\14D: 23RM FMft TO 145434723 1'.01 <br />SAM JOAQUIN COUNTYPUBLIC HEALTH SERVICES <br />AUG 1. 4. ZUU1 ENVIRONMENTAL HEALTH DIVISION � SQ <br />304 CAST WEBER AVENUE, THIRD FLOOR —1 <br />ENV1R0N!.`'Jhc -+ STOCKTON CA 95202 <br />PERMIT `;t ,�,'li � (209) 468-3420 <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT LiJ1_E KAONiPoU pUSINESS/AGENCY ' T t . e <br />AODRESS I kD t2=40(�A q 2:1_0 <br />PftONE� r•Acsinla€_ �Ti�r� Gj�"�-�'23 '�-�1_____5...,_.� <br />TIVG'App01PtTMYcNTDATE,FR—1 , NG -j-1,2,001 1lMC MQr,�� <br />(Pleise.9iva 7 to 10 6uaincsc stays from dato of appilcatig" su'b'i6ni1W11 <br />CHICK DOX TO,EXPEDJTk REQUEST'- SI17.00 FU - REQUL•ST PRUCGSSCo IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE IC! z <br />1 �..PROGRAM ELE&EN FS SEARCH <br />a <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />VNOIrrcGROUNO TANK JUST) CLEANUP SITE (t.OP) ❑ HOUSING ADAyr-MWT jq SOLID WA EYE <br />OTHER CLEANUP SITE (MON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VE111CLH �jj C C �,nn <br />UND�RGRpUND TANK (MOAIITORMG1REMOVAL) 0 DOG KENNEL ❑ DAiRY A 1 U 1! <br />NALAADOUS WASTE GENERATOR O ClilCxFxa raAtlCli 0 DA; TrtEAThfEr1Y plaPdT <br />0 T![>Z PERMIrtEDFACWTY 13MOTEUNOTeL ❑ PUMPEKTKUCKlYAR1)fCHL•MTOILE73 <br />❑ TA1Tio(waooY PikIRCING ❑ POOUSPA <br />D MEDO LAND USE APPLICATION SITES <br />IICRL WASTE FACll1TY O PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPCcir-YAROVE) <br />1. 'List up to rets addresses lr1 the space above. Seteci the tYAe(s) of files from the fist above by checking <br />I the appropriate box{es}. At Icast one file type MUST be s¢IMed. Fax to (209} 4G4 -0Z3$ or mail to the <br />I address indlcgtFd 1lbove <br />2• Elite will notify the applicant if Any END files exist. All appointment for review will be confirmed <br />approxijrtately five buslnoss days but no tater than ten (10) days after MCeipi of applicatfon. -Tho files <br />will be hold for a maximum of five business days for reviow. Appointtments should be Scheduled <br />accordingly. <br />3• iA file that is aeGValy being workad on by EHO staff may not be (rnnIediatoly available for rCVia <br />ppl <br />aication maybe submittctl whan.the rite is available, w. Anew <br />4• ( Any file not returned in ti -to samo condition as rcicascd will be rcorDanized by END staff at the oxpense <br />5, <br />of the applicant. Future file reviews by the Satre applleant may require a $87."TENTATIVE appointnlentydatcss MUST be COnfirmed with EMD staff. 00 deposit prier to review. <br />G, Applications received after 3:00 prn will be processed the next -business day, <br />I CONFIRMED APPOINTMENT DATE <br />DATE CONFIRNIEQ <br />REVI <br />YES NO <br />TIME <br />PHONE FAX <br />REVIEW OATF <br />INITIALS <br />TOTAL P.©1 <br />V =07P <br />' <br />G��i�hJ+s. a i�'i♦,- • ' �`ttr 1 �r�� � ���i <br />. <br />� �,r <br />� <br />; fJ�� <br />i �1 J the, i ,.►••+.��i.�[!� , �l� .' �� _. a L� <br />t!J <br />tlf�' a � 'L �Y ����f•� .. r�.i a � I!��.L.%+1�9�6/� <br />� �. <br />� <br />/��•��1�� <br />a <br />ENVIRONMENTAL HEALTH DIVISION FILES <br />VNOIrrcGROUNO TANK JUST) CLEANUP SITE (t.OP) ❑ HOUSING ADAyr-MWT jq SOLID WA EYE <br />OTHER CLEANUP SITE (MON-LOP) ❑ FOOD FACILITY 0 SOLID WASTE VE111CLH �jj C C �,nn <br />UND�RGRpUND TANK (MOAIITORMG1REMOVAL) 0 DOG KENNEL ❑ DAiRY A 1 U 1! <br />NALAADOUS WASTE GENERATOR O ClilCxFxa raAtlCli 0 DA; TrtEAThfEr1Y plaPdT <br />0 T![>Z PERMIrtEDFACWTY 13MOTEUNOTeL ❑ PUMPEKTKUCKlYAR1)fCHL•MTOILE73 <br />❑ TA1Tio(waooY PikIRCING ❑ POOUSPA <br />D MEDO LAND USE APPLICATION SITES <br />IICRL WASTE FACll1TY O PUBLIC WATER SYSTEM 0 OTHER (PLEASE SPCcir-YAROVE) <br />1. 'List up to rets addresses lr1 the space above. Seteci the tYAe(s) of files from the fist above by checking <br />I the appropriate box{es}. At Icast one file type MUST be s¢IMed. Fax to (209} 4G4 -0Z3$ or mail to the <br />I address indlcgtFd 1lbove <br />2• Elite will notify the applicant if Any END files exist. All appointment for review will be confirmed <br />approxijrtately five buslnoss days but no tater than ten (10) days after MCeipi of applicatfon. -Tho files <br />will be hold for a maximum of five business days for reviow. Appointtments should be Scheduled <br />accordingly. <br />3• iA file that is aeGValy being workad on by EHO staff may not be (rnnIediatoly available for rCVia <br />ppl <br />aication maybe submittctl whan.the rite is available, w. Anew <br />4• ( Any file not returned in ti -to samo condition as rcicascd will be rcorDanized by END staff at the oxpense <br />5, <br />of the applicant. Future file reviews by the Satre applleant may require a $87."TENTATIVE appointnlentydatcss MUST be COnfirmed with EMD staff. 00 deposit prier to review. <br />G, Applications received after 3:00 prn will be processed the next -business day, <br />I CONFIRMED APPOINTMENT DATE <br />DATE CONFIRNIEQ <br />REVI <br />YES NO <br />TIME <br />PHONE FAX <br />REVIEW OATF <br />INITIALS <br />TOTAL P.©1 <br />