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DATE RECEIVED LHU LUQ NUMt5tM � SAN JOAQUIN COUNTY E C E�U E ED 1RONNIENTAL HEALTii DEPARP4ENT nn4 304 E Weber Ave 3rd Floor Stockton, CA 95205 FEB 00)24"68-3420 Fax: (209) 464-0138 Web: www.co.san_joaqu1n.,ca.us/ehd ENVIRONMENT HEALTH PERMIT/SERVICETUB/LIC RECORDS RELEASE A//,,P��PLICATION APPLICANT: �II � ( BUSINESSIAGENCY: ��C(/tJl� ✓7��/�/�1��! �� ADDRESS: S 7'�S-S C7 I PHONE: '16) 3UFACSIMILE: TENTATIVE'APPOINTMENT DATE: Time: (Please allow 10 business days from date of application submittal) 171 CHECK BOX TO EXPEDITE REQUEST-$93.00 FEE—REQUEST PROCESSED IN 3 BUSINESS DAYS SIGNATURE OF APPLICANT lam- �� DATE Departmen Use Only FILE ADDRESS r� —7 UNIT 1. Strcel �- l0 ��4 A V1- G P'3 5 D `_ -To _ ❑ Unit 1 I, 2. Suer d a O G G 3. Street 4. streeCit 3 v �E33 Unit' �n d s. Street 3 a o aty 02 756f, Unit 3 6. StreetC,.9 /��4 e- �! Vt 7. Street L0 231 oty vn U . 8 strep Z g S e. street �C o aty ❑ Unit 5 10. Street ;l— I �� City ee ENVIRONMENTAL HEALTH DEPARTMENT FILES L11,DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑ HOUSING ABATEMENT 91'SOLID WASTE FACILITY LEANUPSITE(NON-LOP) ❑ FOOD FACILITY SOLID WASTE VEHICLE ROUND TANK(MONITOR]NGlREMOVAL) ❑ DOG KENNEL DAIRY OUS WASTE GENERATOR ❑ CHICKEN RANCH PKG TREATMENT PLANT ❑ TIERED PERMITTED FACILrTY ❑ MOTEL/HOTEL ❑ UMPER TRUCKIYARD/CHEM TOILETS ❑ TATTOOBODY PIERCING ❑ POOL/SPA ❑ LAND USE APPLICATION SITES ❑ MEDICAL WASTE FACILITY ❑ OTHER(PLEASE SPECIFY) 1. List up to ten addresses In the space above. Select the type(s) of files from the list above by checking the appropriate box(es). At least one file type MUST be selected. Fax to (209)464-0138 or mail to the address indicated above. 2. EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately five business days but no later than ten (10) days after receipt of application. The files will be held for a maximum of five business days for review. Appointments should be scheduled accordingly. 3. A file that Is actively being worked on by EHD staff may not be immediately available for review. A new application may be submitted when the file is available. 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. Future file reviews by the same applicant may require a$93.00 deposit prior to review. 5. 'TENTATIVE appointment dates must be confirmed with EHD staff. 6. Applications received after 3:00 pm will be processed the next business day. CONFIRMED APPOINTMENT DATE TIME DATE CONFIRMED PHONE FAX INITIALS REVIEWED YES NO REVIEW DATE EHO 48-02-006 6!8!2001