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SEP-03-2010 03 :26 PM TTINS. ENV&ENG 949 2 0517 P. 01 <br /> ! �? SAN JOAQUIN COUNTY EHD LOU NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 800 Eaat Main St. Stockton, CA 95202.3029 <br /> ,: >> h <br /> Ei\1�i ,,� l;�iV, I.,L:,, T,y Tel*ph <br /> one: (209)488-3420 Falx: (209)484.0138 Web;www.$)pov.p <br /> ,5 <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APOL)CAN1Tt J 0 h V\ G It-f i A S <br /> � BUSINESg/AGENCY: rsltf'Ik$ 4'91 �, �hC. <br /> ADDRESS:ESSt 223 27?4 fi'+0.{'t woCITYISTATE/zip: h1 i Motti V r p CR q-2691 <br /> PHONE(1): q 4q- 9 ? 9 4 8 PHONE(2): FACSIMILE; <br /> ttNTATIVE'APPOINTMENT DATE: Q– ! – )b Time: <br /> (pisses allow 10 business days!rpm data o appllcatlon submittal•'TWtarlvs only-must bo confirmed) <br /> CJ CHECK BOX TO EXPEDITE REQUEST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SiCNATORE OF APPLICANT -3DATE 9 –' ~ICJ <br /> IeI Utiftl (�forma!tion: C1 Llst C]Map–Description: <br /> FILE ADDRE=SS EHD USE ONLY <br /> 1Nrlot N Street Nome CRY <br /> 1(0 l_0 IVA% Unit1 <br /> s R o a o� St-acK-t�uh <br /> 2. ^2"'iS 4_apV„is Rogd $tvcklwh - 47/ <br /> 3. % L O'b h 8 _ nit 2 <br /> Roe cl Sto�.dCi�►, � �. <br /> a. 't.q-f9� E�eoh•.?rs R,oac� cStock�-ah < - -- ��,�� 3""�ks �� <br /> 6• ���.t� IR9¢.oQ CS'1;D�K'F4 h <br /> 7. <br /> i <br /> 9. Unit b <br /> Unit e <br /> 8p Ifft bA(a'I��nge of Information Requested: From to <br /> ENVIRONMENTAL HEALTH VEPARTME T FILES r �� '►tvl <br /> Ut(G 4k01JNb TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT [�$OLID WASTE FACILRYNEHICLE !hr <br /> OTHACLEAN VP SITE(NON-LOP) ^ FOOD FACILITY SOLID <br /> AS <br /> UN #0Oiit EiNID TANK(MONITORINOIREMOVAL))JX CT00 KENNEL D DAIRY '1 �rl j,1 <br /> HAtbliiDO44' STE dGNERATOR� vvv �" CHICKEN RANCH ❑WASTEWATER T110TMENT PLANT ��L/ 10 <br /> TIi Aid PEItAthTtiD FACILRY ❑MOTELMOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> `IIITYbGI��bYWIERCING ❑POOLISPA ❑LAND USE APPLICATION SITES <br /> 111196 AL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> w I IV1�1 LPTIC PERMIT RECORDS ARE AVAILABLE:FOR REVIEW' MONDAY FRIDAY 8;00 AM 5'ODPM(EXCLUDING HOLIDAYS) <br /> -.�...w <br /> 1'• ) dr in the apace above. Select the type(e)of files from the list above by checking the appropriate— <br /> bolt s), least one fila type MUST be selected. F I a In_A010_LbW, Address <br /> Ytl t� dta+ ll''rlot be accepted-for additipnal asslatance with fNe addresees,contact the EHD. Applications received after <br /> J:��'prnl vVlii be processed the next business day. <br /> �'. TIyE!''•EwHlS'~viii notify the appilcant If any EHD!Ilea exist. An appointment for review will be confirmed approximately ten(10) <br /> ddyidi d b# a le so or l gl The files will be held far a maximum of five business days for review. Appointments <br /> dh'tsUld bb lacheduled ttocordlnpiy. <br /> �. A iii ,01*t IS actively being worked on by EHD staff may not be Immediately available for review. A new application may be <br /> sUhMittod when:the file Is available. <br /> 4. AtV 010 not returned In the same condition as released will be reorganized by EMD staff at the expense of the applicant. <br /> FO We'616 flsviews by the same applicant may require a$122 deposit prior to review. <br />