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11/04/2011 14:33 88 080 PEM PAGE 01/01 <br /> RECEIVED <br /> DATE RPrFIVFn EHD LOG NUMBER <br /> SAN JOAQUIN Colt L.• L <br /> i, v 04 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTE 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATI N <br /> r <br /> APPLICANT; ' BUSINESS/AGENCY: <br /> f,,1 <br /> ADDRESS:f �O v v< rag,i4 0 lfv-e CITYISTATEIZIP: <br /> PHONE(1): `1<ls' /a" � PHONE (2): FACSIMILE( <br /> T TATIVE'APPOINTMENTDATE- Time; <br /> (Please allow 10 bu5ines3 days fpKayc of opplioation oubm I *Tonf3fivo only-muet b0 confirmod) <br /> ❑CHECK 80X TO EXPEDITE REQUES C O C NLY)-REQUEST PROCESSED IN 3 BUSIN S D S <br /> SIGNATURE OF APPLICANT DATE l <br /> Electronic Information: ❑ List❑ ap-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street fs Street Nd e J City Unit 1 <br /> ... <br /> z. f a T <br /> unit 2 <br /> --- - -3. - <br /> 4. p �J -fl-unit 1 ,�. <br /> 5. 6 yq <br /> 6. . ._._Unit 4 <br /> 7. ; <br /> $ <br /> LJ Unit <br /> L110 <br /> 1/ 7_15 t nits <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT OLID WASTE FACILITYIVEHIC <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ASTE TIRE <br /> "RJJNDERCROUNDTANK(MONITORINOIREMOVAL) ❑DOC KGNNGL IRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PPRMITTED FACILITY CI MOTELIHOTfiLl UMPI R TRUCKIYARDICHEMICAL TOILETS <br /> TATTOOIBODY PIERCING ❑POOLISPA LAND Uee APPLICATION SITED <br /> F-1MEDICALWASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un to ten addressed 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 typo MUST be selected. Fax to(209)464-0138 or mail d tho agdeggs indicated above. Address <br /> ranges will not be accepted-for additional asaietance with filo addrosaca,contact the EHD. Applioatlons received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any FHD 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 maxirnurn of five IRRSi114V*V deyrt fvr ruviefw. Appuintntenta <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 bV the s me applicant may require a$122 deposit prior to review. <br /> 1 D EHO USE ONLY <br /> I <br /> � a P� <br /> EHD 488 07128110 <br />