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9"30 11 01:33p Rich And Jodie 9165140703 <br /> 08/30/2011 13:16 2094698 ENVIHUNMENIAL "M ..--p'2-. <br /> EHDLOG NUMBER <br /> DP'�R I _ SAN JOAQUIN COUNTY <br /> M"� � ENVIRONMENTAL HEALTH DEPARTMENT <br /> i J G 3® 2011 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www-sjgov,Drgrehd <br /> ENVIRONMENTAL HEALTH <br /> (0 <br /> PERMIT;SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: SUSINES51AGENCY: <br /> ADDRESS: �JL�� � CII�G�i`t+�-ilt'. 2LL I 1---' — CITYISTATERIP:("6!' 9t's,?k i., , <br /> PHONE (1)�q 07,2 PHONE(2): FAC5IMILE-q1;�;moi4— t' <br /> TENTATIVE'APPOINTMENT DATE; Time: <br /> (Please allow to business days from date of application submittal-'irertfaflve Only-must he confirmed) <br /> CHECK BOX TO EXPEOTE`"UE:S'r-$125 EE(CA-51-10 CHECK ONLY)-REQUEST PROCESS EO IN 3 9USINESS.DAYS <br /> SIGNATURE OF APPLICA ! ° '�� DATE <br /> Electronic Information: M-i ❑Map-Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> Ta <br /> lLu0 Unit2... <br /> 3. <br /> -�� Unit 1 <br /> 4 <br /> 0 - ,cam lLJ units <br /> 7. <br /> 8. .. - nit& <br /> 10. Unit 6 <br /> Specinc Date Range of Information Requested: From to <br /> ENVIRONMENTAL HETH"F-PARTMENT FILES <br /> :�UNDERGRDUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT tULID WASTE FACILITYIVEHICLE �I <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY -•+gWASTE TIRE 1���f <br /> E]UNDERGRWHO TANK(MONIToRINGIREMOVAL� C1 Dor. N , <br /> KENNEL DAIRY 0`1 11 <br /> 4DAA7AR000S WASTE GENERATOR,. CHICKEN RANCH [RWASTEWATER TREATMENT PLANT <br /> ❑TIERED PEAmrm FAcitrry ❑MOTFL(HOTEL Q FR PuMPTRUCKIYARDICHEMICAL TOILETS <br /> [1 TATTOOIBODY PIEPCING E),POGLISPA '(.ANO USE APPLICATION SRES <br /> ,l Me0 CAL WASTE FACILITY ..0 COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RFCOR13S ARE AVAILABLE FOR REVIEW: MONDAY-FRIQAY 8:00 AM-5:00pm(EXCLUDING HOLIDAYS) <br /> 1. Dist urs to ten addmt1ses in the space above. Select the type(s)of tiles from the list above by checking the appropriate <br /> box(esl. 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 Jf any EHD files exist. An appointment For review will be confirmed approximately ten(10) <br /> days after meal pt of application. The files- ill,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 an by EHD staff may not be immediately available for review. A new application may be <br /> submitted when the file is available. <br /> d. Any file not returned in the same condition as released will be r#organiEEd byEND staff at the expense of the applicant <br /> Future file reviews by the Game applicant may require a$125 deposit prior to review. <br /> G ` Y <br /> AH A6 8J1l11 <br />