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UWU8/2004; 111:41 - .2094671116 AGE STOCKTON - PAGE. 01/0 <br /> ARE EM 1 1'vr;F- F. EHD LOG NUMCER <br /> L U'=E�flj '1lJ' SAN.IOAQUJ.N COUNTY <br /> SEP ENvmommENTALHEALTH DEPARTbJENT 9&10 <br /> 8 2004 304 E Weber Ave 3d Floor Stockton, CA 95205 <br /> ErmRoT -- u j x(209)468-3420 Fax: (209) 464-0138 Web: www.co.sanjoaquin,ca.us/ehd <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE ]APPLICATION <br /> APPLICANT: (ywanip BUSINESSIAGENCY: Qd6mm?d � 9/�1&111r & <br /> ADDRESS 2371')�y SU) Roo r S`bckt tx OA 95WS� <br /> PHONE: '209- YG / ^16O&E FACSIMILE: 1 � <br /> TENTATIVAPPOINTMENT DATE: !VID O9 Tbn� <br /> ne: /'�ui.` <br /> se t (�',,� <br /> (Please allow 10 business days from data of application submittal) ft - <br /> CHECK BOX TO EXPEDITE REQUE T-$93.00 FEE—REQUEST CESSE IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE / Q (Jy((Il <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> US� El Unit 1 <br /> CA � z6ao <br /> ON 4 6 ❑ Unit 2 <br /> s. 5°°" aty Unit 3 <br /> ciy A� <br /> 7. fiawM <br /> Un <br /> 8. SVeN <br /> CRY <br /> 9 fires <br /> ❑ Unit 5 <br /> ro. AtmelCAY <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) Cl HOUSING ABATEMENT ❑ SOLID WASTE FAQ <br /> OTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORIN01REMOVAL) ❑ DOG KENNEL ❑ DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH ❑ PKG TREATMENT PUNT <br /> TIERED PERMITTED FACILITY ❑ MOTELMOTEL ❑ PUMPER TRUCKNARDICHEM TOILETS <br /> ❑ <br /> TATTOO/BODY PIERCING ❑ POOL/SPA ❑ LAND 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. 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$93.00 deposit prior to review. <br /> 51 *TENTATIVE appointment dates must be confirmed with EHD staff. <br /> 6. Applications received after 3:00 pm will be processed the next business day. <br /> b <br /> CONFIRMED APPOINTMENT DATE, TIME <br /> DATE CONFIRMEb PHONE FAX INITIALS <br /> WfEWED YES': NO 17EVIEW:bAT$ <br />