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"ROMMO 0 SAN JOAQUIN COUNTY END LOG NUMnER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> OUT 3 0 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-342 Fax:'(2U9)404;0138 Web; WWwsjgov.org/e <br /> ENVIRONMENT HEALTH q 11 <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION 7 2 <br /> APPLICANT: <br /> ADDRESS; <br /> ` d�r �i�` < F DUSINESS/AGENCY: <br /> clryrstatemp lJ' yta,— �0 7 Zt <br /> PHONE(1): PHONE(2); 7 <br /> FACSIMILE:. —?. 3 .2 5 <br /> TENTATIVE*APPOINTMENT PATE: // �//y AV <br /> (Please allow 10 business days from dat a tl rbmlH —Time: VA-144 _ <br /> CHECK 60X TO EXPEDITE REQUEST• Tontatrve only-must ba confirmed) <br /> E(CASH CHECK ONLY)-REQUEST PROCESSED IN 3 aUSINESS DAYS <br /> SIGNATURE OF APPLICANT <br /> DATE U �d <br /> Electronic Information: ❑hist❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street q Street Name City <br /> 1 0 (] Unit 1 <br /> 2. v a � R I t �� <br /> 3 fT 5J - C51 No / LI UI4. <br /> a n ft p u rr ey <br /> '� t7B3 It rt n u R ,( uyt(ol) (O,NF ,.t QYVI> Umt4 j <br /> 1r h rt +t t1 rL units <br /> 8. 3 F�en�i 3�tb c0/5 <br /> 10. H Uhl <br /> 13 Unit 8 <br /> 1. <br /> 0 - <br /> pec ti pate Range r I` <br /> g of information Requested: From .w�. 5 � Wy <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES f I J�/ Or <br /> UNDERGROUND TANK(UST)CLEANUP SITE LOP /]5 <br /> SyMOTHER CLEANUP SITE(NON-LOP ( ) 0 HOUSING AeA7EMENT ❑SOLID WASTE FACIUTY/yEHICLE (�1 II yyn7 <br /> yk UNDERGROUND TANK(MDNITORINGIREMOVAL 17" - '0 FOOD FACILITY ❑WASTE TIRE <br /> N HAZARDOUS WAgTE GENERATOR4` ) D00 KENNE4 ' "' D DAIRY <br /> D TIERED PERMITTED FACILITY DCNICKEN RANCH D WASTEWATER TREATMENT PLANTD IL PIERCING D MOTEUHOTEL DPUMPER TRUCKRARD/CHMTOILETS4 MEDICAL WASTE FACILITY D POOL/SPA <br /> OTHER(PLEASE SPECIFY) LAND USE APPLICATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONOAY•FRIbAY 8:00 AM-5:OOPM - EXCLUDING HOLIDAYS. <br /> f. List up to ten addresses In the space above. Select the types of files <br /> box(es). At least one file type MUST be selected. Fax to 2091464-D138 or mahl listcabove by checking the appropriate <br /> ranges will not be accepted—for additional assistance with nle addresses,contact the EHD6 Appllicatlonsbrecelvad afterAddress <br /> 3:00 pm will be processed the next business day. <br /> 2. The END will notify the applicant if any END fileg exist, An appointment for review will be confirmed approximately ten(10) <br /> days after receipt le accordingly. <br /> on, The fiiea'Will'be field food 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 EHD staff at the expense of the applicant, <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> END USE ONLY <br /> oB • d <br /> EHD 48.08 9/04/08 <br /> PUBLIC RECORDS RELEABE APP FORM <br />