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R E� Ef— EHD LOG NUMBER <br /> SAN JOAgUIN COUNTY Iwo <br /> AUG U 1 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202.3029 <br /> ENVIRONMENTAL HEALTFrelephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov,org/ehd <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION f, 1� 1 <br /> APPLICANT: �(]� In, BUSINESS/AGENCY: Lien tA.Vx nY <br /> ADDRESS: .7\ N(LY`+7" tV\Ui)I I I-PA CITYISTATE/ZIP:—?-(�WL"A ggqGv <br /> PHONE (1): L7M):71QlP -2zn.) PHONE(2):J(-Z[J] Z2Z &- Dqq FACSIMILE:�"J/J'J�7b'q <br /> TENTATIVE'APPOINTMENT DATE: Time, <br /> (Please allow to business days from date of application submittal-'Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-Z122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIG A URE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street a Elmo?Name Olty Unit 1 <br /> 2. <br /> umt2 <br /> 3. <br /> 4. 3Unit3 <br /> 6. <br /> 6. <br /> nit a <br /> 7. <br /> B. <br /> ❑Unit <br /> 9, <br /> +n <br /> nit 6 <br /> Specific Oats Range of Infor aOon Requestod: Fromto <br /> ENVIRONMENTAL HEA H DEPA MENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILRYNEHICIF <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE >ny <br /> UNDERGROUND TANK(MONITORING(/�REMOVAL) ❑DOG KENNEL ❑DAIRY <br /> V <br /> HAZARDOUS WASTE GENERATOR ` ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> �❑7 TATTOO/BODY PIERCING ElPOOLISPA ❑LAN USE APPLICATION SITES <br /> Ih MEDICAL WASTE FACILITY %OTHER(PLEASE SPECIFY)d.MU.I kVA O_U Vt -k),—P('0,9 <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:OOPfn(EXCLUDING HOLIDAYS) <br /> 1, to Addresses In the space above. Salect the type($)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST he selected. Fax to(209)484,0138 or mall to the address Indicated above Address <br /> ranges will not bs accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after recelpt of application. The files will be hold for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly, <br /> 3. A file that Is actively being worked on by EHD staff may not be Imm$dlately 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 Me reviews by the same applicant may require a$122 deposit prior to review. <br /> 17 enc USE ON�r <br /> EHO fe-0e <br /> oTrnno <br /> zoo/zoo 0 emnTe�ad IH roL0068izOLL XVJ sr 8L tLOz/t0/80 <br />