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0 J/CSB!2084 11:.41' :2054671118 ;?:- AGE;STOCKTON ",.PAGE. 01/.0 . <br /> EN <br /> ti EHD LOG NUMBER <br /> SAN JOAQUJN COUNTY <br /> S E P o EN�oNMENTAL HEAL'TA DEPAR' NEENT <br /> 8 2004. 304 E Weber Ave 3 Floor Stockton,CA 95205 <br /> {209 468-3420 Fax: (209)464-0138 Web:vvvvw.00.san-joaquin.ca_vs/ehd <br /> ENVIRONMEW HEMH <br /> PERMfT/S?ERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:& 4a BUSINEssmuNCY: <br /> ADDRESS: 5 s— <br /> PHONE• .2101?- Vb9_160& FACSIMrLE & D <br /> TENTATIVE*APPOINTMENT DATE: OP Time: <br /> (Please allow I D business days from data)of application submrtt l) <br /> Oa Lj IIS <br /> CHECK 13OX`FO EXPEDITE REQUE T•$93.40 FEE-REQUEST CESSE IN 3 BUSINESS DAYS Q <br /> SIGNATURE OF APPLICANT DATE r O <br /> DepaThmnt Use Only <br /> FILE ADDRESS UNIT <br /> VS �' <br /> ❑ Unit, <br /> s#I?Rt © Unit 2 <br /> 5, <br /> 5b NW <br /> fica Unit 3 <br /> 7. St9m <br /> n <br /> s. sveet <br /> CHY <br /> fittest <br /> ❑ Unit 5 <br /> 10. Street <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SIZE(LOP) ❑ HOUSING ABATEMENT fl 50LID WASTE F <br /> OTHER CLEANUP SITE(NON-LOP) 4 FOOD FACILITY 11 SQLID WASTE VEHICLE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL 0 DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑ CHICKEN RANCH Q PKG TREATMENT PLANT <br /> 0 TIERED PEP AITTED FACILITY ❑ HIOTELIHOTEL ❑ PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING O POOLISPA O LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECI <br /> 1. List up to tars addresses in the space above, Select the type(s)of files from the list above by checking <br /> the Appropriate box(es). At lea$t Ane fele type MUST be selected. Fax to 1209)'464-0130 or mail to the <br /> ddress Indl ove. <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 fife 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 /> S. *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 /> IaOrOlm_ . APPDINTMENT'.DATE . ;�11IIIE'• : :: <br /> •I�AT��cvNFFI�I�i='D` - -:p.. pN�. - . <br /> . _ _ _ _ _ l•f _ �F�A7C: 1l�FTlQI•:�..•: <br /> IwVF1=1iU - = - <br /> Vit• - <br /> EKo.a-os-0as - - - <br /> ers'2M <br />