Laserfiche WebLink
06/0G/2011 16: <br />16:20 9254260106 BUREAU VERITAS PAGE 01 <br />R t IVCD • SAN JOAQUINCOUNTY • _„�. ,..". <br />JUN 0 6 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />ENVIRONMENTAL HEALTH Telephone; (209) 468-3420 Fax; (209) 464-0138 Web: www.sjgov.org/ehd Y/ <br />PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br />APPLICANT: `i Pi BUSINESSlAGENCY:2WY, 614 <br />ADDRESS: l/i0,J Yl/hp� CITY/STATEOP: Y$'� <br />PHONE (1): % 7i7 —1 — to s I PHONE (2):!? r FACSIMILEr'1_ZS— y2_10 - o / Q /o <br />TENTATIVE" APPOINTMENT DATE' o- 13_ -Ir Time: 2O a,n <br />(Please allow 10 business days from date of application submittal .`Tentative only • must be confirmed) <br />❑ CHECK BOX TO EXPEDITE RE UEST - $122 FEE CASHOR CHECK ONLY) - REQUEST PROCESSED IN 3 BUSINESS DAYS <br />SIGNATURE OF APPLICANT DATE &MI/ <br />Electronic Information:Lisap —Description; <br />FILE ADDRESS <br />EHD USE ONLY <br />Unit 1 <br />UNDERGROUND TANK (MONITORINGIREMOVAL)V <br />Street Name <br />City <br />CHICKEN RANCH <br />❑ MOTELMOTEL <br />5 rum , si <br />cI ; <br />N, 'U0 <br />�Unit2 <br />�112Gin *d� SI ; <br />V �r <br />Unit 3Unit4 <br />R7. <br />❑ Unit 5 <br />_P From _.,..LFII <br />ENVIRONMENTAL HEALTH DEPART <br />UNDERGROUND TANK (UST) CLEANUP SITE (LOP) <br />THER CLEANUP SITE (NON -LOP) <br />❑ HOUSING ABATEMENT <br />❑ FOOD FACILITY <br />UNDERGROUND TANK (MONITORINGIREMOVAL)V <br />❑ DOG KENNEL <br />�HAZARDOUS WASTE GENERATOR <br />.1? TIERED PERMITTED FACILITY/n <br />" <br />CHICKEN RANCH <br />❑ MOTELMOTEL <br />❑ TATroofRoDY PIERCING \ <br />©POOL/SPA <br />Q MEDICAL WASTE FACILITY <br />❑ OTHER (PLEASE SPECIFY) <br />to A ff <br />OLID WASTE FACILITYNEHICLE <br />ASTE TIRE 7 <br />DAIRY <br />WASTEWATER TREATMENT PLANT <br />❑ PUMPER TRUCHNARDICHEMICAL TOILETS <br />❑ LAND USE APPLICATION SITES <br />WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-9:00PM (EXCLUDING HOLIDAYS) <br />1. List Uo to ten addresses In the space above. Select the type(s) of flies from the list above by checking the appropriate <br />box(es). At least one file type MUST be selected. F x to 209 464-0138 or ma'I 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 FHD flies 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 accordingif, <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 returnetl in the some 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 $122 deposit prior to review. <br />