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0 0 <br /> f1EG& ED SAN JOAQUIN COUNTY EHD LOG MER <br /> NOV 16 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e <br /> ENVIRONMENTAL HEALTH <br /> — PERMIT/SERVICES - - -PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: I I 'i" e �i i'T Ci'` BUSINESS/AGENCY: G t- ( IC <br /> ADDRESS: 5 .94 CITY/STATERIP: Sar (y-,� r �0 r '(A Q(11()3 <br /> PHONE(1): dI5-5Gf ,F-�F{$ ) PHONE(2). JOS -C] �J` - 5ioljFACSIMILE:_c.15- SCI _ U <br /> TENTATIVE"APPOINTMENT DATE: <br /> (Please -` <br /> allow 10 business days fromtlaw of apphcatlonsubmittalTentative onlyTime: <br /> •must be confirmed) <br /> ❑CHECK BOX TO EXPEDITERE JEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT. 0-- (&� r DATE I 111 ff) <br /> Electronic Information: ❑List❑Map-Description: <br /> FII E ADDRESS EH ONLY <br /> Street ff Street Name Cit, <br /> —nit1 <br /> — <br /> Ia <br /> 3• nit 2 <br /> 4. N �1 <br /> $, unit 3 <br /> 6. <br /> 7. ( i 'ND h Unit <br /> 8. q <br /> g, N() Unit 5 <br /> 10. <br /> Specific Date Range of Information Requested: From Unit 6 <br /> rr�-��� ENVIRONMENTAL HEALTH DE ART ENTFILES <br /> C� ^^o�to <br /> uNDERGROUND TANK(UST)CLEANUP SITE(LOP) t❑#OUSINGABA7EMENT L7JOUD WASTE FACIUTYNEHICLE <br /> DOTHER CLEANUP SITE(NON-LOP) [`'FOOD FACILITY ❑'WASTE TIRE t ' ,, <br /> 91LINDERGROUND TANK(MONITORINGIREMOVAL)O( (�OOG KENNEL [}DAIRY W/)4[JflAZAR <br /> aTIERED PER WASTE EDFACILIT P� 1/� DCHICKENRANCH E:aWASTEWATER TREATMENT PLANT I —11-/0 <br /> ['TIERED PERMITTED FACILITY I <br /> ❑TATTOO/BODY PIERCING K E2'Mo7EL/HOTEL [a"PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> D-ME D PGOUSPA El-w0 USE APPLICATION SITES <br /> Ly mtD1CAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 Ara•5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List uD to ten addresses in the space above. Select the type(s)of files from the list above h checking the appropriate <br /> box(es). At least one file Y 9Adr <br /> type MUST be selected. Fax to thlI 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. 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 appolntmentfor 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 /> q EHe 115E ONLY <br /> S <br /> EHD 4a-06 <br /> D7rMO <br /> Z 099L-L69-9 1,t7 e01601080 d£9Z0 Ol 9l ADN <br />