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TB'd '10101 0 9 <br /> \r SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT 5Qf 8 <br /> DEC 13 2010 600 East Main St. Stockton, CA 95202-3029 uu V <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> LHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> EPERMITFIO'WISER M 'k D ' <br /> APPLICANT: I G ^ham BUSINESS/AGENCY: r. pe) q <br /> ADDRESS: rpQ(� �ifDCuYL,�4U CITYISTATE/ZIP:�_6 tk 6 a., c_, f <br /> PHONE (1): PHONE(2): 4 FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE: 1�2 Time: e,,t <br /> (Please ailaw 10 business days from data f appli tion submittal-"Tentative only-must be CCInArmed) <br /> ❑CHECK BOX TO EXPEDITE REQU 1 Ii.OR CHECK ONLY)-REQUEST PROCESSED IN 3 eUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE L <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHO USE ONLY <br /> Street# Street Name City t <br /> 1. <br /> 74 O <br /> 2, ❑Unit 2 <br /> 3, <br /> 4. ---- 21 Unit 3 ;12I2� <br /> 5. <br /> 6. p Unit4 <br /> 7. <br /> 8. ❑U nit S <br /> 9. <br /> 10. Unit 6 <br /> Spectre Data Range of Information Requested: From I q 5 to O <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES 6Air <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE ' N �( � <br /> OTHER CLEANUP SITE(NON-LOP) ,�yy ❑FOOD FACILITY ❑WASTE TIRE u /! 1 3 - r <br /> UNDERGROUND TANK(MONITORINGIREMOVAL)VY El DOG KENNEL ❑DAIRY I �, <br /> HAZARDOUS WASTE GEN ERATOFV ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMDTEO FACILITY ❑MOTEIIHOTEL ❑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 8:08 AM-5:00PM(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(209)464-0138 or mail 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 EHO 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 /> 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 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$122 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 4846 070110 <br /> TO/TO'd SVSG 89E BTS T 'DNI 'isEm OaJOd 8T:£T BTOE-£T-J3Q <br />