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JUN-14-2010 MON 04:56 PM FAX NO, P. Ol <br /> EHD LOG NUMBER <br /> It it IYi k SAWJbAQUIN COUNTY ENVIRONI>:�L�vl H,JUN 14 Lulu ENVIRONMENTAL HEALTH DEPARTMENT600 East Main St.Stockton, CA 95202-3029 r leh31q (E 464-0138 Web: www.Slgov.o g <br /> ) <br /> PERMITJStRVIC tone: (209)488-3420 F'ax. ('209 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: K0.ren TK y o BUSINESSIAGENCY:DArvLer o., die �cAjLr— <br /> ADDRESS: 50 r rCmon4. Sl' 20 1=1 —_ CITYISTATEIZIP: an Fro l C qqlo5 <br /> PHONE591 -"7572 PHONE (2):r� S - DFACSIMILE:(yfS)S41 7S 10 <br /> TENTATIVE`APPOINTMENT DATE; lime: <br /> (Please allow 10 business days from datj of ap{nc�ellon aubmhfel• Tentadvs.only•must be contimwd) <br /> HECK BOX TO EXPEDITE REQUE T-$115 F l'.(CAW I OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS CLAYS <br /> SIGNATURE OF APPLICANT - DATE G/L/^/O <br /> Electronic Information: [-IList Q Map-Descrip 0n: <br /> FILE ADDRESS _ EHD USE ONLY <br /> Street: Street Name ORy UNt1 <br /> 2 - nit2 I n <br /> .__ -. Illi'i <br /> t <br /> 3. — <br /> I <br /> .-... ._ .. - nit 3 <br /> 4. <br /> 5. nR 4 <br /> 6. 1t _.... <br /> -- - ❑Unit <br /> - ❑Unh6 <br /> 10. <br /> Specific Date Range of Information Requested: From r 0 to <br /> ENVIRONMENTALHiALTHDEPAR MENTFILES SOUDWASIEFACIUTYNEiHICLE <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [I HOuslNG ABATEMENT ❑WASTETIRE <br /> ,Q OTHER CLEANUP SITE(NON-LOP) - ❑FOOD FACILITY []DAIRY <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) CI DOG I(I NNEL [] <br /> HAZARDOUS WASTE GENERATOR [I CHICKEN RANCH ❑PUMPERTRUCKIYARDICHEMICAL TOILETS <br /> ❑TIERED PERMITTED FACILITY CI MOTEIJHOTEL El PUMPER TRU APPLICATION 51TES <br /> ❑TATTOoIBOpY PIERCING C I POOU$PA <br /> ❑ MEDICAL WASTE FACILITY I OTHER(PLEASE SPECIFY) A I S D a(I L.Ta I1 Pe rm I fs and 4r i)"+ fertn 1� <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE!FOR RP_VIEW: MONDAY-FRIDAY 8:00 AM_5:o0PM(EXCLUDING HOLIDA`1S) <br /> 1,. List up to ten addressee in the space above. Seloct the type(&)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. FA c( t 12001464 0196 or mail ethe entire&s indicated ahnnreceived ddress <br /> ranges will not be accepted-for additional ae5ishmce with file addresses,contact the EHD. App <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 app ointmroximatelents ten(10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. App <br /> should be scheduled accordingly. , <br /> 3. A file that is actively being worked on by EHD alai . IG1,be i mtt"av, table for r¢vlew. Anew application may he <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$116 deposit prior to review. <br /> 5. If you need further assistance,please contact Diene Martinez,at(tog)468-3426. <br /> LPD W E ONLY <br /> W77M9 <br /> EXD 4E-06 -_ <br />