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DATE RECEIVED ,, EHD LOG NUMBER© K`-I Vi �1 SAN JOAQUIN COUNTY <br /> ! <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 E Weber Ave P Floor Stockton,CA 95205 <br /> SEP 14 20at9)468-3 420 Fax: (209) 464-6138 Web:vfww.co.san-Joaquin.ca.us/ehd <br /> ENVERON�V',P l HEALTH _ <br /> PERMiTlSERMES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ff 13USINESSIAGE14CY: <br /> ADDRESS: J'Hy ovv -- <br /> PHONE'. Czo ! ��� FACSIMILE' r ..::�� S�- S-10 2- <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-$93 —REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE <br /> Department Use Only 1 <br /> FILE ADDRESS UNIT 4 <br /> r5 <br /> ,. street- Z f0! LAkj')~ J.F0(j%c_ lks 1-2!qotyt7 ❑._ it 9 <br /> 2. sem« q1140 In � O � � _ . I� <br /> 13, Shtet 1 000 1J. �- <br /> CRY <br /> 4. Street �� � aCK" � URIC ' <br /> 5. street <br /> CRY <br /> 6. Street <br /> 7. Sleet CRY <br /> Unit 4 <br /> 9. Street <br /> 9. Sweet CAY <br /> 19. Street j Unit 5 <br /> G <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES. <br /> L'3 NDERGROUND TANK(UST)CLEANUP SITE(LOP) LTJ HOUSING ABATEMEtNT ��LID WASTE FA <br /> f; <br /> CLEANUP SITE(NON-LOP) ❑ FOOD FACILITY ❑ SOLID WASTE YE L <br /> ENNEL RY <br /> iii�iA7�lRD�RMtTTED A GENERATOR <br /> NDERGROUND TANK O RNGIREMOVAL) O MO�{ORANCH G TREATMENTIYARDICHEM TOILETS <br /> [15❑ TTAETTTOpOIBODY PIERCING 17 POOL/SPA TEL l{�E AND USE APPLICATION SITES <br /> L7 MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) <br /> 1. List a to ten addresses in the space above. Select the= <br /> p p types)of files from the list abaye by checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(209)464-0938 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. t <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 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 ates ust be confirmed with EHD staff. <br /> 6. Applications received afte pm will be p cesse usi ssH,t <br /> CONFtRMED.iAPPoiN ENT-D E TIME x <br /> TM _ .s:.. l <br /> - °. .. <br /> DACE COl�fF1RMED HONE:r FAX. ITIALS <br /> REVIEWEDYES NA R 'IEW DATE .. ,.._ <br /> ' EHO 48-02.006 'a . <br /> W/2003 <br />