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1i11V14V1U Ua .Zf ren IA001/001 <br /> FILAW \m E® y �r <br /> SAN .JOAQUIN COUNTY EHD LOG NUMBER <br /> �;C l 1 U 2OlO ENVIRONMENTAL HEALTH DEPARTMENT <br /> e 600 East Main St.Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HEATLWhone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/eh <br /> 7`�/ <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATI <br /> APPLICANT: _ Et.awliY.bS BUSINESS/AGENCY:_&),O_� W14(dfcs <br /> ADDRESS: '1414 NS p�rt�.1t'D M0eA",rit OCITY/STAT=P: Sft_Ur <A 95SIV <br /> PHONE(t): (9!6*-07,W PHONE(2)I_ (Q(641-7,81 fi FACSIMILE: 010 41 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please alloy 10 business days from data of application submittal.-Tonfadva only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE FE OR C,4E9KONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE $ ! <br /> Electronic Information: ❑Llst Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Street Name City _ El Unitj <br /> 14361 rAsT Sr L eDt U5 OES , �IZ111 l5 I,I�� <br /> Ur_ 2. 112.1,5- <br /> 611 LackA " Cr 4 t ❑una2 <br /> 3. D � L�ol ; Or✓S, <br /> 4. nit 8 <br /> 5. <br /> nit 4 <br /> T. - <br /> 8. <br /> ❑Unit S <br /> 9. <br /> 10. <br /> unit e <br /> Specific Date Range of Infomtatlen Requested: From ALL to ALL <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACUTYNEHK:LE <br /> OTHER CLEANUP SHE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE ' 'I I _ <br /> UNDERGROUND TANK(MONHORINGIREMOVALO ❑DOG KENNEL [I 'DAIRY �-q <br /> HAZARDOUS WASTE GENERATOR OC "` ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT I/- )q'�o <br /> ❑TIERED PERMITTED FACILITY ❑MuTELIHOTEL ❑PUMPER TRUCK/YARDICHEMCAL TOILETS <br /> ❑TATr017IBODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDK:AL WASTE FACaHy [❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 5:00 AM-5:0OPM(EXCLUDING HOLIDAYS) <br /> 1. List Un to ten addresses in the space above. Select the type(s)of files from the Ilst above by checking the appropriate <br /> box(es). At(east one file type MUST be selected. Fax to 12091464-0138 or mall to the addreas 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 K any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The Tiles will be held for a maximum of five business days for review. Appointmente <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EMD staff may not be immediately available for review. A new application may be <br /> submitted when the file Is available. <br /> 4. Any filenot 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 rosy require a$122 deposit prior to review. <br /> EHD DBE ONLY <br /> t <br /> ENo ee.asf t 0mvio <br />