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vv. vv. vi aa.a iv.tV i'nn aiV JUV lV1J 11LG 11`IPBLUGlt LEg U <br /> —. — EHD LOG AGER <br /> CiE 7 —... SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0 5 304 E Weber Ave 3`d Floor Stockton,CA 95205 <br /> MAR 2004 :wvvw.co.san joaquinca us/ehd <br /> (209)468_3420 Fax, (209)464-0138 Web <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> ,�ice,,,«, (,(� BUSINESS/AGENCY: <br /> � <br /> APPLICANT: � / P� <br /> ADDRESS: 501"1 .1�r/� "7V <br /> FACSIMILE: <br /> C�`CP L/LL <br /> PHONE: � a <br /> TENTATIVE*APPOINTMENT DATE: <br /> Y' <br /> Timer <br /> —ME Copy <br /> (Please allow 10 buses <br /> ins"fMmate°'aFp submittal) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST $93.00 FEE—RqUEST PROCESSED IN 3 BUSINESS DAYS <br /> ,v_. DATE <br /> SIGNATURE OF APPLICANT Department use Only <br /> UNIT <br /> FILE ADDRESS <br /> CA <br /> ,. $treat <br /> M . u <br /> X 2. Street t�l Unit <br /> 3. Street <br /> 4. Street Unit 3 <br /> 5. Street <br /> 2 <br /> C sire 2 UTut 4 <br /> r. Street .1 <br /> s. street ❑ 11Ra 5 � O <br /> 10. Street -�7 i�5 3/1 <br /> #/ . <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES CtR), <br /> ❑ }LOUSING ABATEMENT j�SOLID WASTE FACILITY ,, _ Pr V— <br /> SOLID WASTE VEHI E <br /> UNDERGROUND TANK(UST)CLEANUP SITE(Lop) ❑ FOOD FACILITY �` K ' ..f J h n <br /> THER CLEANUP SITE(NON-LOP) O DOG KENNEL ❑ DAIRY <br /> UNDERGROUND TANK(MON(TORINGIREMOVAL) 13 CHICKEN RANCH �--pKG TREATM PLANT TOILETS Cor <br /> HAZARDOUS WASTE GENERATOR ❑ MOTEUHOTEL O PUMPF.RTRUCKIYARD/CHEM Pc�rJ`J- <br /> ❑ TIERED PERMITTED FACILITY ❑ POOt1SPA LAND USE AAPLiCATION SITES <br /> ❑ TATTOO/BODY PIERCING ❑ OTHER(PLEASE SPECIFY) <br /> ❑ MEDICAL WASTE FACILITY Select the type(s) checking <br /> • List up to ten addresses In the space above. e <br /> esse s)of files from the list <br /> above by <br /> the appropriate b . At least one fife type MUST be selected. Fax to 209)46"138 or mail to the <br /> address indicated above. EHD files exist. An appointment for review will be confirmed <br /> 2. EHD will notify the applicant if any after receipt of application. The files <br /> approximately five business days but no later than ten(10)days ointments should be scheduled <br /> will be held for a maximum of five business days for review. App <br /> nev <br /> 3• A file that is activ <br /> accordingly. <br /> ely being worked on by EHD staff may not be immediately available for review. <br /> application maybe submitted when the file is available. xpe <br /> aff at the ense <br /> a, Any file not returned in the same condition as released will be reorganized by EHD stsit or ere nsc <br /> of the applicant. Future file reviews by the same applicant may require a$93.00 depo <br /> 5, <br /> *TENTATIVE appointment dates mmswil bconfirmed <br /> prf locceess with he next business day. <br /> g• Applications received after 3:00 p <br /> TIME <br /> CONFIRMED APPOINTMENT DATE --- - INITIALS <br /> DATE CONFIRMED PHONE FAX <br /> REVIEWED <br /> YES NO REVIEW DATE <br /> EHO 46-02-006 . <br /> yg72003 <br />