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RECE NE SAN JOAQUIN COUNTY r EHD LOG NUMBE <br /> r . <br /> NOV 0 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 952023029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: BUSINESSIAGENCY: <br /> ADDRESS: CITY/STATE/ZIP: �;.�G �c}I 21 <br /> PHONE(l): ��((�\ ►{�- pZ3b PHONE(2); (3�� zt- 5+t. FACSIMILE:�glb (go- t,601 <br /> TEN ATl E'APPOINTMENT DATE: Time: <br /> (Please allow 10 buslness days from date of application submittal-'Tentative 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 fo�lt((I <br /> Electronic Information: [] List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street it Street Name City Unit I <br /> 1. Ib3o �T���ne Aw i iwte cy Sha k�oh _ <br /> (tp2 Unit 2 <br /> 3. 2�o ae' <br /> 4. �SZg , \`,f t� jn <br /> 6. , " �ztC�/fy-C) F/)liJS '`�7. <br /> Spocific Dato Rango of Information Requested: From A" to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> [ I DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT 21OILIB WASTE FACILI YIVEHICLE <br /> rER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY wi!� E TIRE <br /> riDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ,[ Y <br /> ARDOUS WASTE GENERATOR ❑CHICKEN RANCH LrfWA TEWATER TREATMENT PLANT <br /> V <br /> FILRED PERMITTED FACILITY ❑M ELIHOTEL PER TRUCKIYARD/CHEMICAL TOILETS <br /> ❑ <br /> TATTOO/BODY PIERCINGTPOL/SPA f117NID USE APPLICATION SI'TESr' <br /> �IIEDICAL WASTE FACILITY L✓1 VTHER(PLEASE SPECIM A,,j c",As p eKv��»Kr�tw�U( C4vtccrh. <br /> WELL AND SEPTIC PERMIT RECORD$ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AM-S:QLM(EXCLUDING HOLIDAYS) <br /> 1. List up to ten addresses In the space above. Select the type(s)of flies from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(2091464-0136 or malt to the address 1041pated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. 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 flies 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 retumed 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 /> EHD USE ONLY <br /> EHD ra-0e <br /> 0�/Y91i 0 <br /> 100/L0018 XUf EE LO LLOZ/ZO/LL <br />