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1 1L_I/L—1 V L—L> <br /> JUN 0 7 2011 . �ubmltbyEmali PriltPorm <br /> 0 <br /> DATE RECEIVED SAN JOAQUIN COUNTY t�1 <br /> COnta(ENVIRONMENTAI HEALTHENVIRONMENTAL HEALTH DEPARTMENT" °— <br /> Yvette PERMIT/SERVICES <br /> direct phone 600 East Main St. Stockton, CA 95202-3029 <br /> ty 209-468-3421 Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> or Cheryl Field PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: a rS2- X' 5 BUSINESSIAGENCY: A I<T CCJv Sr I wo <br /> ADDRESS: 2 Ofd (� utolo CITY/STATE/ZIP: wc.(v �� G✓r.¢ la/CC A��� <br /> PHONE(1): �Q2fl `t�� PHONE(2):qd, -6C FACSIMILE:SQ2;�� q-"G— �o O9_ct <br /> TENTATIVE-APPOINTMENT D TE: Time: <br /> (Please allow 10 bualnese d from data of application submittal.—Tentative only-must be conflrmaQ) <br /> ❑CHECK BOX TO EXPEDITE REQ S - 15 F (GASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE fo L 12-61 <br /> Electronic Information: 0 Lls Map—Description: L 2 r T1R e— <br /> ec ^S� t Fr pkr <br /> FILE ADDRESS EHD USE ONLY <br /> street# Street Name City Unit 1 <br /> 1 Ca DQO.i Lt-Ce-s' Ave, C..f7 a f t—ems -DE--I Ah <br /> 2.3. ` G Jt.} Cl✓ /"�" Unt 2 <br /> Fd;E 11 ]WQ <br /> ��_ Unit 3 <br /> a. f fe <br /> B Unit 4 <br /> 7. <br /> 8, p Units <br /> 9. <br /> 10Unit 6 <br /> Specific Date Range of lnfcn UOn Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILESk! <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) E]HOUSING ABATEMENT SOLID WASTE FACILITYNEHICLE„b <br /> OTHER CLEANUP SITE(NON-LOP) ❑Fool)FACILITY WASTE TIRE ) '�3 <br /> UNDERGROUND TANK(MONITOWNrL F]rjREMOVADOG KENNEL DAIRY <br /> HAZARDOUS WASTE GENERATORI/�, [:j CHICKEN RANCH WASTEWATER TREATMCNT PLANT 01Iif, <br /> ❑TIERED PERMITTED FACILITY VVV [�MOTn/HOTEL PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY 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-S:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List uo 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 Flle type MUST be selected. Fax to 209 464-0138 or mall to the address Indicated above. Address <br /> ranges will not be accepted•for additional assistance with file addresses,contact the EHD. Appllcatiens received after <br /> 3:00 pm will be processed the next business day. <br /> E <br /> 2. The EMD 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 /> y not be Immediately available for review. Anew application may be <br /> 3. A file that Is actively being worked on by EHD staff ma <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 /> 6. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> EMD Us0 ONLY <br /> J <br /> a1241s9 <br /> EHD 4t•OB <br /> TO/10 39Vd S1Ntil-lrISN00 I3V 66099PLSZG 89:0T TTOZ/LO/90 <br />