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DATE RECEIVED - - 'EHD LOG NUMBER <br /> IFrc , "I ESD) SAN JOAQUIN COUNTY <br /> Ulf�. y I I, �I"IESD) ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 4 ZO 304 E Weber Ave 3`d Floor Stockton, CA 95205 <br /> SEP <br /> (QL�9)468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.uS/ehd ap <br /> ENVIRONf01BIl HEALTH <br /> PERMiUSERVIM PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:./ BU�S,IN,EoS'SfAGENCY: Cbf�/SIJ "�'AfI�Y <br /> ADDRESS:( fc�,4� �dcI, 'p-'� "1 a�""� 7� f0O U C" <br /> PHONE: V P (1 �'2"'� 0 FACSIMILE: g 'f1 I S-10 Z <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> '—' <br /> CHECK BOX TO EXPEDITE REQUEST-E93 -REQUEST PROCESSED NBUSINESS DAYS � <br /> SIGNATURE OF APPLICANT DATE <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I- S'.'- 2 eOl J r LsYI4— city <br /> 0 �5 ❑ unit 1 <br /> 2. sut 12 40 KI fnD a / <br /> 3. s�.2000 N. M&ryt— <br /> '1 O a -.!`.-Unit 2. . <br /> {. Shea <br /> 5. Street cfty <br /> 6. sued aty <br /> 7. $1f0et aty Unit 4 <br /> e. shee CRY <br /> 9. street Unit 5 <br /> 10. street - G <br /> �� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> BjUNDERGROUND TANK(UST)CLEANUP SITE(LOP) o HOUSING ABATEMENT rJ�SOUD WASTE FAoil <br /> THER <br /> UP STTE(NON-LOP) 0 FOOD FACILITY <br /> OLID WASTE VEEL; <br /> D TANK <br /> KENNEL <br /> RY <br /> �L TIERED PERMITTED ACNLRY O RNGlREMOVAL) ❑ MO EllN RAN H 13_P_� GMAPTREATMENTER PLANT <br /> A CHEM TOILETS <br /> ❑ TATTOWBODY PIERCING ❑ POOLISPA �LIWD USE APPLICATION SITES <br /> ❑ 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(209)464.0138 or mail to the <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 files <br /> will be held for a maximum of five business days for review. Appointments should be scheduled <br /> accordingly. <br /> 3. Afile 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 ame condition as released will be reorganized by EHD staff at the expense <br /> of the applicant. Future file evie s by the same applicant may require a$93.00 deposit prior to review. <br /> 5. 'TENTATIVE appointment fatesiust be confirmed with EHD staff. <br /> 6. Applications received afte 0 pm will be p ocesse the4fM sin ss <br /> CONFIRMED.APPOINTMENT D 7E )� TIME <br /> DATE CONFIRMED PHONE i' FAX tyITIALS <br /> REVIEWED YES + NO W., Rl �IEW DATE <br /> EHD 4"23 06 <br /> VW003 <br />