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05/23/2012 22:03 888480 PEM PAGE 01/01 <br /> E - EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> d';:i '( 2 4 201? ENVIRONMENTAL HEALTH DEPARTMENT U50 600 East Main St. Stockton,CA 95202-3025 ���yy/ <br /> 3QIephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br /> MIR LHERLfH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> C— 1 <br /> APPLICANT. ? �WF�"- �(f0L.L>S �- 1 t3 USINESSIAGENCY: of <br /> ''J <br /> ADDRESS: 5a�> W. IF( ciplti.t.?`n.. ��CITYISTATEMIP:�P <br /> PHONE(1') 710- 5'7 A D PHONE(2): FACSIMILE &7 <br /> T TA VE`APPOINTMENT DAT E: Ti <br /> _ me: <br /> (Please allow 10 business days date of application su i Temative only,must be confirmed) <br /> ❑CHECK BCXTO EXPEDITE REQU FE OR W K LY)-REQUEST PROCESSED IN 3 SUSIN S DA <br /> SIGNATURC or APPLICANT — DATE S <br /> Electronic Information: ❑ List❑Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> StreetStrwtName y City t <br /> 1• [� orvt �L, o i o-. <br /> 2. p0 a <br /> 3- l9 o `7 f I 0(U(i} l�7 � / <br /> 4. 0 q / L ,©units <br /> s• t�5 63 �r No I PiNX - <br /> O' 1 ,ET Unit a <br /> • <br /> 8' `s ❑unit 5 <br /> g. Cj rn n N0 1i 3 1%Wil t3 LA/� <br /> 1 D. ©'Unit 6 <br /> SpocUTc Date Range of Information Requested: From m <br /> F!NIA <br /> UNDERGROUNUTANKtUSi)CLEANUPSRE(I.OP)RONME ]HOU INGABATEVENT RTMENT FILES 1 f Un WASTE FACILfTyNEliicLE ?S �� <br /> OTHER CLEANUP SITE(NON•LOP) ❑FOODFACILITY ❑WAsTETiv- <br /> UNDERGROuNGTANK(MONITORING/REMOVAL)V— ®DOO KENNEL ❑DAIRY <br /> AZARDOUSWASTEGENERATO" CWICkEN RANCH Q WASTEWATERTRFATMENT PLANT <br /> TIERIED PERMITTED FACILITY pt\ ©MOTEIIHOTEL ��❑--,,``PUMPER TRUCKIYARDICHEMICAL TCILE(S <br /> TATTOo/GoDY PIERCING ❑POOLISPA �,17l,AND U9G APPLICATMN SITES <br /> MEDICAL WA5IEFACILITY ©OTNER(PLEASESPECIFY) / <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FPoDAY S:OO AM-S:ODPM(ExCLuolNe HOLIDAYS) <br /> 1. List up to tan addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> bex(es). At least one file type MUST be soleat Id. Fax to(209)484.0138 or mail to the add1ess indleated above. Address <br /> ranges will not be accepted-foradditional 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 hold for a maximum of five business days for n view. 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 he <br /> submitted when the fila is available. <br /> 4. Any file not returned in the same condition as released will be reorgatawd by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$422 deposit prier to review. <br /> y cue use eui. <br /> ( "I 2'1('� 3 <br /> 7� 4 <br /> ESO Ga•Ofi 07129110 <br />