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UNIT <br />0 Unit -1 <br />0 UT* 2 <br />/Unit 3 <br />/ <br />Unit 4 <br />0 Unit 5 <br />j.(Parr,Vi L, <br /> <br />E.HD LOG NUM9i7. <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL BEALTH DEPARAMENT <br />304 E Wcber Ave 3rd :Floor Stockton, CA 95205 <br />468-3420 Fax: (209) 464-0138 Web: www.co.san-joaquin.ca.us/ehd <br />Z 1 4 7 <br />PUBLIC RECORDS RELEASE APPLICATION <br /> 21 "(005 <br />CIP) ENVIRONMENT r-tq <br />PERM1T/SERVIC ES <br />APPLICANT: \'1 <br />ADDRESS: (102_ Td.01:62sj, so N,1 <br />PHONE: (9NCC1D77O FACSIMILE: e9lbq 36C1 '12Z5 <br />,1i /153th-I3USINESS/e^-,GENCY: A.) <br />TENTATIVE"' APPOINTMENT DATE <br /> <br />5 <br /> <br />Time: Ot <br /> <br />(Please allow to business day.; from date of application submittal) <br />El CHECK BOX TO EXPEDITE REQUEST - $93.00 PEE - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT fik0A-1A1 DATE 12-1,2_‘\ <br />Der,artme.nt Use Only <br />FILE ADDRESS <br />. Gime!.8alia„.. JA__yCgLn__4, A.I.ie.., CA)/ .5trcle,1.-uv, <br />2, zt,,,:(_At ay 5.10CY.A-alr1 <br />3 Sirv7I a'7/ Lky.a4/.1- I OSLR)A___________qi'y__ 517,CX-Atc-tek fly ' ...). <br /> Stree 2 OZ2- (1,,,k4.-pr 1,64) 'I2-pk_ city 4-i.,,,:_.K.A..=-41. <br /> Strtmt aass cAgeroy.sg. le-d, c4,1, . 3 'nx-KAr:41 fv,i. --') -. <br />G, sirect ..1.5 ilLA-IsOr.Ar• Icy...,'"*R64. ci: <br />7. Srcel .20 VI_ tx10,,A-t) tlx, elz...zt cl <br />Cry <br />5-t-ocr-T1,-4 , •\,) <br />.:5"%i 14-4e:•^PI <br />:;) q <br />k___ 8 SInitot 00C> Wck-Accil- t•:)c) ,.._dr, <br />3 sireN city <br />iO, Strett Cry <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />67:UNDERGROUND TANK (UST) CLEANUP SITE' (LOP) <br />tq, OTHER CLEANUP SITE (NON-LOP) <br />LG" UNDERGROUND TANK (MONITORING/REMOVAL) <br />/HAZARDOUS WASTE GENERATOR <br />Lq. TIERED PERMITTED FACILITY <br />0 TATTOO/BODY PIERCING <br />0 MEDICAL WASTE FACILITY <br />HOUSIN3 ABATEMENT SOLID WASTE FACILITY <br />0 FOOD FACILITY 0 SOLID WASTE VEHICLE <br />DOG KENNEL 0 DAIRY <br />0 CHICKEN RANCH O PKG TREATMENT PLANT <br />0 MOTEL'AOTEL PUMPER TRUCK/YARD/CHEM TOILETS <br />0 POOL/SPA LAND USE APPLICATION SITES <br />0 OTHER (PLEASE SPECIFY) <br />List up to ten addresses in the space above. Select the type(s) of files from the listaboye by checkin -J <br />the appropriate box(es). At least one file typc MUST be selected. Fax to (209) 464-0138 or mail to the <br />address indicated above. <br />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 />A file that is actively being worked on by EHD staff may not be immediately available for review. A ne, <br />application may be submitted whsn the filc3. IL, availablE.,.. <br />Any file not returned in the same condition as released will be reorganized by EHD staff at the expens,: <br />of the applicant. Future file reviews by the vine applicant may require a $93.00 deposit prior to reviel <br /> <br />5, *TENTATIVE appointment dates must be conIrmed with EHD staff. <br /> <br />6. Applications received after 5:00 pm will be processed the next business day. <br />CONFIRMED APPOINTMENT DATE TIME <br />DATE CONFIRMED NONE FAX INITIALS <br />REVIEWED YES NO REVIEW DATE <br />EMP RiS/2001