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OATE'RECEIVEd :.r EH0 LOG NUMBER <br /> FD) <br /> `-� SAN JOA00N COUNTY <br /> Lssi EL ENVIRONMENTAL HEALTH DEPARTMENT <br /> 5 P Z� 304 E Weber Ave 3rd Floor Stockton,CA 95205 <br /> �9)468-3420 Fax: (209)464-0138 Web:www.co.san-Joaquin.ca.us/ehd <br /> EfNVIRONNIE J HEAff H <br /> PERM€T EM SS PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 13USINESSIAGENCY: <br /> ADDRESS: J LtfY Xvd bk- I r'+( -S 00 1j! 4�L <br /> PHONE: (Sol) fril -"O¢ FACSIMILE. 1_0 1 �� �^� S-10 2- <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dat of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93 —REQUEST PROCESSED IN 3 BUSINESS DAYS. <br /> SIGNATURE OF APPLICANT DATE L <br /> Department Use Only <br /> FILE ADDRESS UNIT <br /> I. Street- 2 01 r c,d-rte o ,�95 <br /> 2. street 12. O I rt c` �s ❑ blit 1 <br /> 3. su'.e.2000 N, d'z1 O G ! <br /> Unit?- <br /> S. Sweet city <br /> 6. Street CRY <br /> 7. street G Unit 4 <br /> S. stye t <br /> s. street Unit 5 <br /> 19. Stred city <br /> ENVIRONMENT/AL.HEALTH DEPARTMENT FILES 50 <br /> gdNDERGROUND TANK(UST)CLEANUP SITE(LOP) l7 HOUSING ABATEMENT _ r�LID WASTE FA _ <br /> 9jOTHER CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE VEI­ <br /> '07 <br /> PZUNDERGROUND TANK p NGIREMOYAL) � <br /> !MOUS WASTE <br /> ER © N RA CH �G TREATMENT PLANT <br /> Eff TIERED FACILITY M <br /> i���P�APER TRUCKJYARDICHEM TOILETS <br /> E3 TATTOOISODY PIERCING ❑ POOLISPA IVLAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY E3 OTHER(PLEASE SPECIFIC <br /> 1. List up to ten addresses in the space above. Select the.type(s)of files from the list abase 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. Anew . <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 evieby the same applicant may require a$93.00 deposit prior to review. <br /> 5. *TENTATIVE.appointment aes ust be confirmed with EHD staff. <br /> 6. Applications received afte pm will be p cesse . h si s <br /> ONFIRMED �AP <br /> CPQiNTMENT,D E r '=.�.n TIME <br /> i <br /> BATE CONFIRMED = r30NE FAX'" IJ 1TIQC.S <br /> REVIEWED . YES NO R IEW DATE. j: <br /> EHL)48-02-096W. <br /> 81$r240� <br />