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EHD LOG NUMBER <br /> DREUMVED <br /> SAN JOAQUIN COUNTY • <br /> ENOONMENTAL HEALTH DEPARTMRIT <br /> FEB 0 9 2010 600 East Main St. Stockton, CA 95202-2708 <br /> T phone: (209) 468 3420 Fax: (209) 464-0138 Web: www.sjgov.org hd09Q <br /> ENVIRONMENT HEAll v 0 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: kk's lybyI'\4VLa-�' BUSINESSIAGENCY:_F' 'DD *'(/o(_'1/i tu�yLG <br /> ADDRESS: wA /VI�LG L CITY/STATE/ZIP: do M (✓20 <br /> PHONE (1): Zb7�A7� -53-&-- PHONE (2): FACSIMILE:J_1_467 <br /> TENTATIVE`APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$115.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> V ,SIGNATURE OF APPLICANT >V,( � DATE 2 ei f 6 <br /> Electronic Information: ❑ List❑WIG—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> \ Street# Street Name City ❑Unit 1 <br /> 1. 1�2 f=av rL U� oz l r7�5/ 'n/ --- <br /> gh 2 2`� } (� `J C _ U T OZ I 0if_C W Unit e <br /> 3. \" <br /> 4• Unit.3' <br /> 5. <br /> 5. nit 4 <br /> 7. <br /> 8• El-Units <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: From -1 O to <br /> ^,� ENVIRONMENTAL HEALTH DEPARTMENT FILES��/ t'rn <br /> L YuNDERGROUND TANK(UST)CLEANUP SITE(LOP) ElE HOUSING ABATEMENT SOLID WASTE FACILITYIVEHICLE <br /> ❑l/OTHER CLEANUP SITE(NON-LOP) [:1 FOOD FACILITY [—]WASTE TIRE f� f� <br /> N NDERGROUND TANK(MONITORINGIREMOVALK [j DOG KENNEL a❑LY.I DAIRY <br /> lV <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT H r <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY 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 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up ten addresses 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 EHD 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$115.00 deposit prior to review. <br /> 0 MaA ONLY <br /> ***If you need further assistance (e a contact Diane Martinez direct) E? (209)468-3425. Thank You*** <br /> - Ila) -ID: <br /> l0ll l <br /> vun vasa Ilrt (/U 11 u fir} &kT <br /> eM <br />