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SAN JOAQUIN COUNTY 171`10 LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 00 3 0 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3d2e Fax.'(209)464-0138 Web; www.sjgov.orgle <br /> ENVIRONMENT HEALTH t 7 02 <br /> PERMIT!SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ca BUSINESSIAGENCY: <br /> ADDRESS: _Z2 �,P�Q/� c�GS1X`" /42 CltylStatelZlpV- 72 <br /> 47 <br /> PHONE(1): — PHONE 2): � <br /> ( FACSIMILE:' ,� � - <br /> TENTATIVE*APPOINTMENT DATE: Time: 'A <br /> (Please allow 10 business days from date of appli tion submittal-'Tentative only-must be Confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUET- -"— E(CASH CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE • e) .4 <br /> Electronic Information: [I List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> Il7Z G. �i (] Unit <br /> 2, tr a n (( It ❑ Unit <br /> 3. Q t( is ,I (I rt 0'-5 ��� \ ' \ <br /> 4. It (1 tl �L TOES/ UD �Cy"il� Unl <br /> 5. /'fi r r' \� <br /> fl tl 1t tt 11 o �t t( <br /> Il11oCo/yr Unit4 <br /> 1t ti U i <br /> ❑ Unit 5 <br /> 8' c Ir n tt tt ►t <br /> ft <br /> uY,,i 3"b c0/� <br /> 9. 3 <br /> II U/� (� ❑ Unit 6 <br /> 14.�' <br /> 0 -iflc Date Range of Information Requested: From w� 5 J <br /> .J ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> '4 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT ❑ SOLID WASTE FAciurYNEHICLE � I I � ✓ <br /> XOTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY 0 WASTE TIRE ( Q <br /> yITUNOERGROUND TANK(MONITCS K ' <br /> ORING/REMOVAL)VL 0 DOCS • E3 DAIRY <br /> A W � � / L <br /> HAZARDOUS WASTE GENERATOR4- 13'CHICKEN RANCH I] <br /> ©TIERED PERMITTED FACILITY M MoTEUHOTEL 13WASTEUMPEP TRUCATER TREATMENT PLANT <br /> E3 TATTOO/SoDY PIERCING ❑POOLISPA ❑LAND USE APPLCATON SITES oILETS <br /> D MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) /l e rWELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REviEw- MONDAY-FRIDAY 8:00 AM-5:00M - EXCLUDING HOLIDAYS- <br /> 1. List up to ten addresses In the spare 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 file$exist., An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files'wlll 15. held fdr,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$105 deposit prior to review. <br /> EHD USE ONLY <br /> EH0 48.06 B/04/08 <br /> PUI5LIC RECORLS RELEASE App FARM <br />