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FROMFF c, ica1/HiF <br />1-tWQEN <br />0L' <br />72011 <br />-ical Con PHONE NO. : 510 6548635 <br />SAN JOAQUIN COUNTY <br />JUL. 07 2011 08:45RM P1 <br />EHD LOG NUMBER <br />JUL, ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />ENVIRONMENTALERV HEgI�T hone: 209 468-3420 Fax: 209 464-0138 Web. www.sjgov.org/ehd <br />PERMIT/SERVICE$$` p ( ) ( ) <br />PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT:OXtzNGj!r _. z/V' v p` <br />,BUSINESS/AGENCY:/�/�C`� <br />ADDRESS. r��� �i - `" CITYISTATE.IZIP: Ul�'± Z X"v <br />PHONE (1): PHONE (2): FACSIMILE:�a <br />TENTATIVE* APPOINTMENT DATE: UL �s�, 20(( Time: `=o D,uj <br />(Please allow 10 business days from date of application tubmittal - *Tentative only - must be confirmed) <br />CHECK BOX TO EXPEDITE RE T - $12Z FEE (CAa/% - CH EQUEST PROCESSED IN 3 BUS NESS (JAYS <br />SIGNATURE OF APPLICANT�c �uv�<e�' DATE %/'J // / <br />Electronic Information: ❑ List n Map — <br />���-' <br />�• <br />Street a <br />3.� <br />Street Name <br />S. C-0,4? 1,7 'e-�� <br />city Unit 1 <br />N o f <br />Ze❑ Unit2 <br />nit 3 <br />Unit 4 <br />..-��✓ <br />2. <br />l i <br />S- Gt7 <br />$. <br />6. <br />t FCS <br />7- <br />-3 <br />8, <br />G lU <br />Gi. Sp d <br /><< I nit8 <br />01 <br />� � A In ,A F) I-1 I In Ff R <br />8pocMc Data Range of Infonnation Requested: From to <br />EN\nRONMENTAL HEALTH DEPARTMENT FILES 5 <br />�Q UNDERGROUND TANK (UST) CLEANUP SITE (LOP) ❑ HOUSING ABATEMENT 0 SOLID WASTE FACIUTYNEHICLE <br />+ v i 14ER CLEANUP SITE (NON -LOP) ❑ FWD FACILITY L] WASTE TIRE f p <br />Q UNDERGROUND TANK (MONITORINGMEMOVAL)�<, ❑ DOG KENNEL ❑ DAIRY <br />Q'HAZARDOUS WASTE GENERATOP�, ❑ CHICKEN RANCH ❑ WASTEWATER TREATMENT PLANT --7— 17 -�I <br />TIERED PERMITTED FACILITY © MOTELIHOTEL ❑ PUMPER TRUCKIYAROICHEMICAL TOILETS <br />❑ TATT00/lioDY PIERCING EJPDDL/SPA Q LAND USE APPLICATION SITES <br />❑ MEDICAL WASTE FACILITY © OTHER (PLEASE SPECIFY) <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8.00 AM-S:OOPM (IJ(CLUDING HOLIDAYS) <br />1. i {st up to ten addresses in the space above. Select the "(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) 4§¢0138 or mail to I;tJe 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 now application may be <br />submitted when the fila 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 $122 deposit prior to review. <br />