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triD LOG NUMB1.1 I <br /> HN a <br /> M -OUNTY <br /> SAN JOAQUIN <br /> L <br /> ENVIRONMENTAL HFALTH DEPARTME,Nr moomh <br /> NV 2 0 2007 304 E Weber Ave 3"' Floor Stockton, CA 95205 0% <br /> FNARONMENT SIE kJW)468-3420 Fax: (209) 464-0138 Web: www-co.san-joaquin.ca.Tsjhd <br /> PERMIT/SERVICES %0I 00e <br /> PUBLIC RICCORDS RUEASE APPLICATION <br /> APPLICANT- -BU$INESSIAGENCY! <br /> ADDRESS:- ]_A0j 000-A o <br /> PHONE: 3te—+ - 3—1D FACSIMILE: 3 Loi -A <br /> Z <br /> TENTATIVE*APPOINTMENT DATE, —Time', CFO <br /> (Please allow 10 business days from date of application submittal) <br /> CHECK BOX TO EXPED]Tr-REQUEST-$93.00 FEE-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Oaoartment Use Only <br /> FILEADDRESS UNIT <br /> I, Street -5SINA' N. Unit 1 <br /> - & 3931 N <br /> 2. av at /111 <br /> 0_4 <br /> :1. 9 3 2- A] City Unit 2 <br /> 4. S—Vell 1 U f" N-C"j to► -\ k� cAly Al <br /> 5. 1—Aff' Unit 3 <br /> �Q A A- C11 <br /> street 410 9 N4, -v' 11 Nkik <br /> al <br /> 0 <br /> 7. street 7_+3-2- /\1" lkt Unit 4 <br /> 0. Street :5 7- N ci!y.--/ V\ <br /> 9. slrm't city Unit 5 <br /> L10. <br /> ENVIRONMENTAL HEALTH DEPARTMEN A6. <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) n HOUSING ABATEMENT 0 SOLID WAS <br /> 7Z OTHER CLEANUP SITE(NON-LOP) 0 Fool)FACILITY C3 SOLID WASTE VOCLE <br /> UNDERGROUND TANK(M ONTTOPINGtREm OVAL) 0 DOG KENNEL 0 DAIRY , <br /> HAZARDOUS WASTE GENERATORX, 0 CHICKEN RANCH C3 PKG TREATMENT PLANT <br /> TIERED PERMITTED FACILITY�( 0 MOTEUHOTEL 173 PUMPER TRUCKIYARDICHr:tM TOILETS <br /> Ix <br /> 0 TATTOO/lBoDY PIERCING 0 POOL/SPA 0 LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> I List up to ten addresses in the space above. Select the type($) 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. 11110I <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 recdipt of application. The file�� <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 <br /> applicatlon may be submitted when the file is available. a <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 /> E14D 40_02sq& <br />