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RPR-3-2012 10:428 FROM:GEOPHRSE ENO 2095690295 TO:4640138 P.2 <br /> )CEIVED1HD LOG NUMBER <br /> SAN .IOAQUIN COUNT � <br /> .� 0 3 201? ENVIRONMENTAL HEALTH DEPARTMENT <br /> pphhqq 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENTALTTee��eeHEAt Nne: (209) 468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd W <br /> PERMIT/SERVICES PUBLIC ,ERECORDS RELEASE APPLICATION <br /> APPLICANT: S72?le, /&a 14 r'� 8USINESS/AGENCY6Zeo//�4t_r Gam' y <br /> ADDRESS: „�q37 I e'liyam Agl-e CITY/STATE/ZIP: <br /> PHONE(1): 4' q O-2d/3 PHONE(3): FACSIMILE:,�(��I SC��-O��J <br /> TENTATIVE'APPOINTMENT DATE: / / Time: <br /> (Please allow 10 business days from date—of application submittal--Tenfative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT. DATE <br /> Electronic Information: ❑ Llst❑Map-Desc 1ption: <br /> FILE ADDRESS EHD USE ONLY <br /> Street C Street Name City Unit i <br /> 1. ..1`Y ,r.�✓ST>^ic/ Orr � ;UY rf_Q'S �.._ `; <br /> <. 2. _ , /c X punit2 <br /> 3. <br /> 4 S _ ...... _. _ _ [] t 3_ <br /> 6. — /3liZ nR4 <br /> ��r _ <br /> 7. <br /> 8. unit <br /> 9. <br /> 10. ❑Unit 6 <br /> Specific Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> .ISI UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT El SOLID WASTE FACILITYNEHICLE <br /> UNDERGROUND <br /> SITE(NON-LOP) ❑FOOD FACILITY F1 WASTE TIRE <br /> U� NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL E]DAIRY <br /> aHA2ARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOUSPA El LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY E]OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:OOPM(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 EHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will behold 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 /> EHe USE QNLY <br /> Ott w /Le . � � ✓tR� �� <br /> cc b <br /> EHD 4906 -- 07129/10 <br />