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,12/20/2611 N16:27 93345174 WGR SOUTHWEST INC PA E <br /> F I LO <br /> E °' SAN ,1(JAQUIN COUNTY LEE <br /> �� 2 O 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95202-3029 <br /> • E \#�RONMENTALH I phone; (209)465-3420 Fax: (209)464-013$ Web: www,sjgov.org/ehd <br /> I E a ITISERVICE 0aiW � X51 '�G1^G� <br /> USLIC RECORDS RELEASE.APPLICATION <br /> APPLICANT: S"u ` �' r �r f- SUSINESSIACENCY: <br /> ADDRESS: 3f r tom/. 1 � e S I" er 6 CITYISTATEIZIP: <br /> PHONE(1): q 331 14 -S X63 xzpPHONE(2): ---- -- _ FACSIMILE; Z0 <br /> TENTATIVE""APPOINTMFNT DATE: A- ,.M� `� 2 v I Time: <br /> (Please allow 10 business days from date of applicatl n submittal-*Tentatfvc only,must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUES 125 FEE(CASH CR CH^ ONLY)-REQUEST PROCESSED IN 3 BUS NES AY$ <br /> SIGNATURE OF APPLICANT DATE f- f `� I f <br /> Electronic Information: L] List© Map—I7escrlption: _ <br /> FILE ADDRESS EHD uSE ONLY <br /> Street# Street Name City ❑ Unit 1 <br /> 2. _ w I-� A v C 5 k �o+n it 2 <br /> d Un <br /> D ✓n..ti a. '� G D <br /> 3- rSe 9 —1A ,�e I I I�a�� a�i r roc fie,ne� ��T o t <br /> 4. g o Pj, - .-,e oA,Ic A YI- t Unit 3 <br /> h'I6t5ovti4-2/QodrFG,� vJ� <br /> �i I.,,-+a r--a.���,v 4.. . �t Unit a <br /> 7 <br /> $ .,. Units <br /> 9. <br /> 0 ... ._. (� Unit 6 <br /> Specific Date Range of Information kequested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> RrUNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT OLID WASTE FACILITYIIIEHICLE <br /> OTHER CLEANUP Srm(NON-LOP) ❑FOOD FACILITY 0WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/PEMOIIAL) Doc KENNEL Q DAIRY <br /> AZARDOUS WASTE GENERATOR ❑CHICKEN RANCH Q WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL [ PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOOlSODY PIERCING ❑POOL/SPA LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONPAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List into ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At(east one file type MUST be selected. Fa o 209 4_6_4&I 38 or mail to the ddress indicate eve. 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 some 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$125 deposit prior to review. <br /> I, 0 1St:ONLY <br /> • <br /> EHD 4808 <br />