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DATE RECEIVED EHD LOG NUMBER <br /> R�������� SAN .10AQUIN COUNTY • <br /> C ENRONMENTAL HEALTH DEPARTAT /•� <br /> Q 2D12 1868 East Hazelton Avenue, Stockton, CA 95205-6232 `�l <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT(SERVICERVICES PUBLIC RECORDS r A�SE A-PPN ATI <br /> APPLICANT: t7 L� U�� BUSINESS/AGE Y: ) " <br /> ADDRESSz=7o"�/�c�//—�iur r;?f O G S. —CITY/STATE/ZIP: P�O <br /> PONE (1): PHON (2 : FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from to application submittal-*Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$125 (CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSIN SS DAYS <br /> SIGNATURE OF APPLICANT DATE �� f J� <br /> Electronic Information: ❑ List❑ Ma escription: <br /> XFILE ADDRESS EHD USE ONLY <br /> Street# / Street Name City Unit1 <br /> 1. 2 06 T'I �a LS 4n/ 16r- 0 <br /> 2• ❑ Unit 2 <br /> 11 3. <br /> 4. <br /> Unit 3 <br /> 5. <br /> B• Unit4 <br /> 7. <br /> 8. ❑Unit 5 <br /> 9. <br /> 10. ❑ Unit s <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES / <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑MEDICAL WASTE FACILITY ❑SOLID WASTE FACILIT,YNEHIC ,J p <br /> OTHER CLEANUP SITE(NON-LOP) ❑HOUSING ABATEMENT ❑WASTE TIRE 'y 1,;qtP�rj 4�to{I3 <br /> NDERGROUND TANK(MONITORINGIREMOVALV, FOOD FACILITY ❑DAIRY ),r�rM IDZIZ-/Z <br /> ABOVEGROUND TANK CHICKEN RANCH/DOG KENNEL ❑WASTEWATER TREATMENT PLANT <br /> AZARDOUS WA9TEIHAZARDOUS MATERIALSDL ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICALTOILETS <br /> TIERED PERMITTED FACILITY ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING ❑COMPLAINTIRESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0138 or mail to the address indicated above. Address <br /> ranges will not be accepted-for additional assistance with file addresses, contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> 4. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$125 deposit prior to review. rrBOXEO AF EAsEHD"USESeori <br /> IC IZ-1 Z': 4f)�Oftj <br /> Records provided by StaffPPR_Complete. Staff Name: <br /> -tit <br /> 4a-06 914112 <br /> I <br />