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Apr 16 09 11 : 07a DORIS SPECH 9167764860 P. 1 <br /> HOMO <br /> �/ EHD LOG NUMBER <br /> 1���1(17T1"`_-: D SAN.IOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ^ O <br /> APR 1 6 2009 600 East Main Street, Stockton, CA 95202-3029 ov <br /> Telephone: (209)468-3420 Fax: (209)464-0136 Web:www.sjgov.org/ d 2 <br /> ENVIRONMENT HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIZERAffsT <br /> APPLICANT: L/.'ln i.< Ll G(''A/-7 BUSINESSIAGENCY: ��<T/7 /S <br /> ADDRESS: �4/r�.�/,+ -�itl ✓ /�p/.� �5�. f7% .3 Ccltylstatelzip 1d1/ Nisi V,, K%4 <br /> PHONE(1): _T74 -�/0/412r4HONE(2): FACSIMILE: A 776-/%/3 <br /> TENTATIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submitral-'Tentative only-must be confirmed) <br /> W CHECK BOX TO EXPEDITE REQU IT-5105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT A '-i DATE <br /> Electronic Information: ❑ List❑Map- escription: <br /> FILE ADDRESS EHD USE ONL <br /> Street s Street Name City <br /> ' '❑ Until <br /> 1. ' vL/ , Nc S/ <br /> �y �) F71NAuY F} R2 <br /> 3. -.: <br /> 4. <br /> 5. <br /> 6. 4 \� <br /> 7. — ' ❑ Unhs <br /> 8. <br /> 9. <br /> __ ❑ Unit <br /> 10. <br /> Speck Date Range of Information Requested:From to <br /> yENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> . <br /> y-PNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 13 SOLID WASTE FACILITYIVEHICLE !• 1t- N� <br /> OTHER CLEANUP SnE(NON-LOP) 13 FOOD FACILLTY C3 WASTE TIRE r, ✓111 111 <br /> -PLUNDERGROUND TANK(MOMTORINGIREMOVAL)D( ❑DOG KENNEL 13 DAIRY <br /> p IN • ,I'I�r apt <br /> HAZARDOUS WASTE GENERATORS CIciacKEN RANCH ❑WASTEWATER TREATMENT PUNT <br /> TIERED PERMITTED FACILITY 40'- ❑MOTELIHOTEL 173 PUMPER TRUCKIYARDICHEM TOILETS <br /> E3 TATTOOISODY PIERCING El PODLISPA ❑LAND UsFLICATION SITES 1 <br /> O MEDICAL WASTE FACILITY �OTHER(PLEASE SPEGFY) L,') T/�n� CTiN/:F.0-/!`N 1 <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW-M0NDAY-FRIDAY8:00AM4:OOPM -EXCLUDINGHOLIDAYS. <br /> 1. List up to len addresses In the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)46"138 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 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. 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 /> EHD 48-06 8104108 PUBLIC RECORDS RELEASE APP FORM <br />