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04/12/2012 12 :45 FAX Z001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> RECEIVEDENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> 2�1� Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov,org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:_KAI-1r<-- Eb-j;�3 BUSINESSIAGENCY: I� P-r-ml S l(IGr �!•� L <br /> ADDRESS: `Z <✓ CITY/STATE/zIP: NIT(��Gg `�*5'8Z) <br /> PHONE(1): 6° -pZ3`7� PHONE (2): FACSIMILE'.: f6,) <br /> -Vt�3_'ok>o-3 <br /> TEN TIVE'APPOINTMENT DATE: ( 2 01 Z Time: A h�- <br /> (Please allow 10 business days from dot of appIl atlon submittal.•Tontadve only-murt be confirmed) <br /> PR CHECK BOX TO EXPEDITE REQUEST- 5 FE H OR ECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATEZ— <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Strut 8 Street Name City <br /> 2800 S, <br /> 2. 2 0 C tfi l�. S �" nit-2 <br /> 3. 2400a 5, C6-t f T 4"T NO �,U� �� N <br /> Unit s <br /> r7. <br /> ��t 1 C - �-A-P i'T (c_ � j Unit 4. r Unit 6 <br /> L <br /> Unit 6 <br /> i <br /> Speclflc Date Range of Information R*quested; From _ to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILrry/vEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) Q FOOD FACILITY WASTE TIRE r f 7 <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)L. ❑DOG KENNEL []DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT � <br /> TIERED PERMITTED FACILITY to ❑MOTELMOTEL ❑PUMPER TRUCKNARDICHEMK AL TOILETS <br /> TATTOOIBODY PIERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS []OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC Pi_RMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPMl EXCLUDING HOLIDAYS) <br /> 1. List un 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 (2091464-0138 or Mail to the addreS$ t . 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, Anew application may be <br /> submitted when the file is available. <br /> 1 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 512E deposit prior to review. <br /> _I ✓s -1 SF O LY- <br /> rYI t �5 0 <br /> d Z 77 V 5 <br /> r <br /> 8!'IM 1 <br /> END 48.oe <br />