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DATttE E SAN ENO LOG NUMBER <br /> 1 Y ,JOAWIIIN COUNTY <br /> iu11 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 %6q <br /> Fax: <br /> 464-0138 Web; <br /> 68-3420 <br /> jgov.o <br /> ENVIP RMITI E tiIG PUBLIGRpRW: (209) aRECORD$(12ELEASE APPLICATION rglehd <br /> APPLICANT: 4.br'Y BUSINESSIAGENCY: E�ucev. S.�i,ccs t <br /> ADDRESS: 31134 CITYISTATE/ZIP: 54"r&Y Ce 4. 6A 9511., <br /> PHONE (1): 91A q'Fo- 7�7,!g PHONE (2): FACSIMILE: 0603 <br /> TENTATIVE'APPOINTMENT DATE:Y eAl( to 5 u.If- Time: <br /> (Please allow 10 buslness days from date of application submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQ EST-S1 2 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE P,,,A V-I/ <br /> Electronic information: ❑ List Map—Description: <br /> FILE ADDRESS END USE ONLY <br /> Street tl Street Name City t <br /> 1. 3550 Hca <br /> z. 3 y'$O ~ S�o� <br /> 8• 3 3� U` 'T IL1�7��� t06-511113 <br /> I � <br /> 4. u Unita <br /> 5. <br /> 5' 41 UnIt4 <br /> 7. <br /> 8. <br /> ❑unit s <br /> 9. <br /> 10. <br /> ❑Unit <br /> Specific Date Range of Informatlon Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES —�i��y� G' <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) [I HOUSING ABATEMENT El SOLID WASTE FACILITYNEHICLE � <br /> OTHER CLEANUP SITE(NON•LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)%4 0 DOG KENNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR` ❑CHICKENRANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTDO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION STIES <br /> ❑ MEDICAL WASTE FACILITY p OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List up 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 file type MUST be selected. Fax to!2091404-0138 or mall to the address Indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END, Applications received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The END Will notify the applicant If any END filar exist. An appointment for review will be confirmed approximately tan (10) <br /> day$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 END 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 ENO staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$122 deposit prior to review. <br /> 11-q-11 <br /> 1J - EHO USE ONLY <br /> Q <br /> ENO ease <br /> 07rsens <br /> 100/1.00In XVd Ll ll IIOZ/0Z/01. <br />