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1Q 001/001 <br /> � I/ �V/GV IV VJCf THn <br /> ®® C ` ��® EHD LOG NUMBER <br /> Int m SAN JOAQUIN COUNTY <br /> I;!I^'i 1 O 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> NTAL H hone: (209)468-3420 Fax: (209)464-0138 Web: www.sigay.org/eh 7el <br /> PERMITESER C <br /> PUBLIC RECORDS RELEASE APPLICATI <br /> APPLICANT: ly � Eu'ON"s BUSINESSIAGENCY: & cQ va-g(clES <br /> ADDRESS: SL}'jl-�},,MmF- ,,11 pae CITYISTATEIZIP: SAL t't ,-74-ly CCA ci5$IN- <br /> PHONE (1): �916}(80^o2SL{ PHONE(2): FACSIMILE <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please al low 10 businass days from date of appllcatl.n submittal-'TantatNe only-must he confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUE FE OR C ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE $ <br /> Electronic Information: ❑List Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Streets Street Name City Unit <br /> of Icy' BAST ST l-"D t 0'' I I I I-1 <br /> 2. 12 )) 6AST L cdh jr % ❑Unit2 <br /> 3. p eFa�l C1.uFTr Lo91 /r C��5 <br /> nk 3 <br /> 4. <br /> 5 <br /> 61 4F <br /> 7. <br /> __.._._ ❑Unit S <br /> 9. <br /> Unit e <br /> 10. <br /> to AI Z <br /> Spedfk Dab Range of Information Requested: From <br /> J r r — <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES i ����/�j/�� <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT ❑SOLID WASTE FACILBYNEHICLE 6) <br /> OTHER CLEANUP SITE(NON-LOP) ❑FDDD FACILITY ❑WASTE TIRE U-14If <br /> UNDERGROUND TANK(MONDORINGIREMOVAq? ❑DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR A \ ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT 11- 14-10 <br /> 70 <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPERTRUCKNARDICHEWCAL TOILETS <br /> ❑TATTOWBODY PIERCING ❑POOLISPA ❑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-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uD 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 209 484-0138 or mail to the . 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 H any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of appllcation. The files will behold 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 EHO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> EHD UDE ONLY <br /> II -1_I 0 : Ltd 5 <br /> _ r v <br /> n (� <br /> Ff 7UPi D <br /> EHD 4945 <br />