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-- `01/03/2005 02:30 91 3290 DELTA w <br /> PAGE01 <br /> RECEIVED <br /> ANIS 0 2 2012 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> DATE RECEIVED <br /> SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> 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/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> MATT, <br /> APPLICANT: I ATT, 5m&_LF'y BUSINESS/AGENCY: /tp'NTf} Cpeayr <br /> ADDRESS: 11 - wti 11 G /(dry doge CITYISTATE/ZIP: 116wi(MO ts; (,/¢- 45 <br /> PHONE(1): 41G 34(> 01,3()11 PHONE(2): yfb 966 32NU FACSIMILE: —1 <br /> TENTATIVE'APPOINTMENT DATE -- <br /> Msaae avow 10 bualness days from dela of a hcahon submittal Time: <br /> PP Tentative only.must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST $125 FEE(CASH OR CHECK ONLY(-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE 4�-3-Zoll <br /> tiectronlc Information; ❑List❑Map-Description• <br /> FILE ADDRESS <br /> EHD USE ONLY , <br /> street e <br /> arrest Noma City <br /> W147 W <br /> 2.3. <br /> ---- — - <br /> ------ --- — --- --O <br /> a. <br /> -RupR3O <br /> nitA <br /> 7. <br /> I_Q_ 8(PC'N (&�ej <br /> t.------ <br /> 10. <br /> ❑Unit 6 <br /> $PaOIYIc Date Ranpe Ol Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY +❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONRORINGIREMOVAL) El DOG KENNEL ❑DNRY <br /> ❑HAZARDOUS WASTE GENERATOR ED CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTEL/HOTEL <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA ❑PUMPERTBULKICATION SITES TgIETS <br /> ❑ MEDICAL WASTE FACILITY ❑OTHE (PLEASESE SPECIFY) <br /> WELL <br /> ❑COMPLAINT RELOROS E)OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILA13LE FOR RENEW; MONDAY-FRIDAY 8:00 AM-B:DOPN1(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses in the space above. Select the types)of files from the list above by checking the appropriate <br /> busies). At least one file type MUST be selected. Fax to(208)464-0138 Or all to the address indicated above Address <br /> ranges will not be accepted-for additional assistance wnh Flle 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 recalpt of application. The files will be help for a maximum Of live buslness 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 retumed In the same condnlon ae released Will be re011janlaed by EHD staff at the expense or the applicant. <br /> Future Nle reviews by the same applicant may require a$125 deposit prior to review. <br /> rHoxeae <br /> enm <br />