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1 x28/2004 13:24 FAX 209 9480to <br /> 0003 <br /> E IZ� <br /> ®ATyCIVlr® <br /> SANJOAQUMCOUNTY <br /> ENTMONMENTAL HEALTH DEPART NT <br /> 304 E Weber Ave 3'd F16or Stockton,CA 95205 <br /> (209)468-3420 Fax: (209)464-013$Web:vrww.co.sm-joaqum-c&us/ehd. <br /> LIC RECORDS RELEASF, APPLICATION <br /> AP c,r. Jcl'i'�v� BUswESSIAGFNCY: �- <br /> ADDRESs: <br /> PHONE; <br /> FACSIMILE. meg/ <br /> TENTATIVE`APPOINTMENT DATE: 1/�t IQq Time: <br /> (please allow 40 business days from date of apPlIMUOn subtWdlal) <br /> CHECK BOX To EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT I _` '''`��' DATE 1 Ta ' <br /> Departirmt Use OtdY <br /> FILE ADDRESS UNIT <br /> a. p Unit 1 <br /> N r z fo„ <br /> I-tf'_1_...�, (ems u.\4o:•n. a..)Iq Unit 2 <br /> 4. God h� � <br /> SLG CftLk�n Unit 3 <br /> 19' <br /> JA <br /> . _ .�J\— S. shed 4 <br /> a. Swel <br /> " 7 Sheel unit 4 <br /> e. Sfteet <br /> ❑ Unit 5 <br /> 9. sued J- <br /> 10. 5(ed <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESt8000 <br /> ()RtUNDERGROUND TANK UJST)CLEANUP SITE(LDP) 13HOUSING ABATEMENT 4M 50UD WASTE FACILITY <br /> fa OTHER CLEANUP SITE(NON-LOP} <br /> E3 FOOD FACILITY Q SOLID WASTE VEHICLE <br /> KQ pTREATMENT PLANT <br /> M UNDERGROUND TANK(MONITORINGIREMOVAL) ❑ DOG KENNEL <br /> US WASTE GENERATOR 13 CHICKEN RANCH alt PICC T <br /> in O MOTELMOTEL ® PUMPER TRUCK/YARp(CIIEWI TOILETS <br /> ❑ T{ERED PERMITTED FACILTIY Q PA � LAND USE APPLICATION S� <br /> ❑ TATTOMODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> O MEDICAL WASTE FACK-UY <br /> 1. List up to ten addresses In the spate ve. Select the (s)of files from the list above 4Y checking <br /> the appropriate box(es). At least one file type MUST be selected. Fax to(2091464-0138 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 s,f 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. Anew <br /> application maybe submitted when the Else is available. <br /> 4. Any file not returned in the same condition as released wilt 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. <br /> -TENTATIVE appointment dates must be confirmed with EHD ff. <br /> B. Application's received after 3:00 pm will be processed the next business day. <br /> 77 <br /> GI' l]• PPQINTMF-NT- b4T:E ,"! :':�:c: TIME Y a ,. t._- 1'..`., •' <br /> � ��'P . �1SX. <br /> ATE• ¢NFRNE® <br /> REVI ED a YES RiMEW DATE. •-:i <br /> ' EFC®4a-0Z.Oa6 . <br /> �rarz�a - <br />