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May 15 08 1225p Paul Humphrey (559) 226-3408 p.1 <br /> L„(�{�� `( p�� EHD LOG NUMBER <br /> �`—'U{ILEI' 'lug D SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Q ./ <br /> MAY 1 5 2008 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjg V.D <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: Rt K j Alm BUSINESSIAGENCY: <br /> ADDRESS: -T G _ %•' ->� /M$ ./-2-t <br /> PHONE(1). 5_2/ 7 7/�9rJ PHONE(2): FACSIMILE: `-) <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> -ter /_-, (Please allow ten business days from date of application submittal--Tentative only-must be confirmed)• '. •,•. •:. •, <br /> y �£CK BOX TO EXPEDITE REQUEST-$98.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN THREE BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City 0Unit I \(;\ <br /> 1. 3�j Z 4-= <br /> s. 2735 L �� l <br /> 4. r _ 1i p n s <br /> 6. _ nit 4 <br /> 7. <br /> 8. o unit s <br /> 9. <br /> 1 D. /enil 6 <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL PARTME S <br /> tx UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING TEMENT LID WASTE FACILITYNEHICLE <br /> �THERCLEANUP SITE(NON-LOP) 13 FOOD FACI LITY WASTETIRE <br /> 2SWNDERGROUND TANK(MONITORING/REMOVAL) ❑DOG KENNEL ❑ DAIRY <br /> 25HAZARDOUS WASTE GENERATOR 13 CHICKEN RANCH 'AU WASTEWATER TREATMENT PLANT <br /> ;R-TIERED PERMITTED FACILITY ❑MOTEL/HOTEL ❑PUMPER TRUCKIYARDICHEM TOILETS <br /> El TATTOO/BODY PIERCING 0 POOUSPA ❑LAND USE APPLICATION SITES <br /> 0 MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECOROS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 6:00 AM-S:OOPM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Selectthe type(s)of files from the Ust above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0136 or mail to the above address. Address ranges will <br /> not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after 3:00 pm will <br /> 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 <br /> days after receipt of application. The files will be held fora maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that is actively being worked on by the EHD staff may not be immediately available for review. A new application <br /> may be submitted when the file is available. <br /> 4. Any file not returned in the same Condition as released will be reorganized by EHD staff atthe expense of the applicant <br /> Future file reviews by the same applicant may require a$98.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHDa846 20MMY PUBLIC RECORDS RELEASE APP FORM <br />