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(V ll EHD LOG NUMBER <br />MM f cr- <br />[D SACT JOAQUIN COUNTY LTJ ENVIRONMENTAL N VIRONM ENT,A„L HEALTH DEPARTMENT <br />NOV [0 - 304 E Weber Ave 3r`' Floor Stockion, CA 95205 <br />09) 468-3420 Fax: (209) 464-01.38 Web:www-co.sazt joaquin.ca us/ehd <br />ENVIRONMENT HEALTH <br />PERMIT/SERViCES PUBLIC RECORDS RELEASE APPLICATION L <br />APPLICANT:1 111Q BUSINESSIAGE;NCY: <br />ADDRESS: 1oz <br />PHONE: 0I1' aV_7-M l ' FACSiMiLE; _�i"K2 l %q- I2Z 2r <br />TENTATIVE* APPOINTMENT DATE: I)PLC-- (,1 ZC05- Time: R A <br />(Please allow 10 business days from date of application submittal) <br />E3 CHECK BOX TO P_XPEDiTE REQUEST - $93.00 FEE -REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT �wa DATE tt/Zr-/03 <br />Department Use Only <br />ENVIRONMi~NTAL HEALTH DEPARTMENT FILES <br />UNiT <br />0 HOUSING ABATEMENT <br />❑ Unit 1 <br />(] Unit 2 <br />FILE ADDRESS <br />❑ SOLID WASTE VEHICLE <br />UNGROUND TANK (MONITORINGIREMOVAL) <br />ZUnit4 <br />0 DAIRY <br />DOUS WASTE GENT=BATOR <br />�Tlr_'"ED <br />C 1 CHICKEN RANCH <br />2. <br />sVeet <br />to MOTELIHOTEL <br />+'i t� <br />AAN <br />CRY <br />3. <br />SI etqquiff <br />nM+F <br />fid. <br />�& <br />riM� <br />Gl ! <br />S. <br />Sweet <br />-7 <br />'T11.` <br />f V �' <br />Gt % t<-Ar"A <br />s. <br />` <br />&tree✓ <br />0 <br />10 C,ir-x- <br />Ave <br />Ot <br />�. <br />street <br />9, <br />i1rtr4 <br />oily <br />9. <br />Street <br />G <br />10, <br />str"I <br />clix <br />ENVIRONMi~NTAL HEALTH DEPARTMENT FILES <br />UNiT <br />0 HOUSING ABATEMENT <br />❑ Unit 1 <br />(] Unit 2 <br />® FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNGROUND TANK (MONITORINGIREMOVAL) <br />ZUnit4 <br />0 DAIRY <br />❑ Unit 5 <br />U;(UNDF,RGROUND TANK (UST) CLEANUP SiTE (LOP) <br />0 HOUSING ABATEMENT <br />E7 SOLID WASTE FACILITY <br />OTHER CLEANUP SITE (NON -LOP) <br />® FOOD FACILITY <br />❑ SOLID WASTE VEHICLE <br />UNGROUND TANK (MONITORINGIREMOVAL) <br />C3DOG KENNEL <br />0 DAIRY <br />DOUS WASTE GENT=BATOR <br />�Tlr_'"ED <br />C 1 CHICKEN RANCH <br />0PKG TREATMENT PLANT <br />PERMITTED FACILITY <br />to MOTELIHOTEL <br />© PUMPER TRUC:K/YARDICHEM TOILETS <br />© TATTOOIBODY PIERCING <br />0 POOUSPA <br />13 LAND USE APPLICATION SITES <br />* MEDICAL WASTE FACILITY <br />EO 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 (20S) 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 />5. '"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 />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED PHONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />