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Y �• s [V fL L UI IYI �� � �, <br /> [- PATE RECEIVED4 <br /> EHD LOG NUMgEFt <br /> ® ® SAN .JOAff <br /> � .C I V ENVIRONMENTAL. P I R <br /> YETMENT <br /> 600 Fast Main 5t, Stockton, CA 95202-3b29 <br /> APP 9 2012 Telephone: (209)468-3420 Fax: (209)464-0138 Nab: www.$jgov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITIsERvlCEs PUBLIC RECORDS RELEASE APPLICATION <br /> i <br /> APPLICANT: )I Q h Q ]� EU$INES5IAGENGY: < <br /> ADDRESS: <br /> if CITI/STATI"/ZIP: 33053n , . <br /> PHONE(1): 1R�2 l�.�q'—}��� 1�__ PHONE (2); FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE; Time: <br /> (Please allow 10 busln68s days from date of application submittal-!Tenlailua only-must be confirmed) <br /> # ANA <br /> ECK BOX TO LXPEDI fE REQ T-$125 F I' <br /> ( SH OR CHECK ONLY) REQVF-8T PROCESSED IN 3 B 51N SS DAYS <br /> $fRlr OF APPLICANT DATE , <br /> I Electronic Information: Description; <br /> FILE ADDRESS EHD USE ONLY <br /> i S[raet# 81rest Nama City <br /> 1. ❑Unit t <br /> r <br /> 2. <br /> L]Unit 2 <br /> 4. 1 <br /> %le <br /> 8. <br /> Unit 4 <br /> r. s [ <br /> 9. <br /> ` M units <br /> 10. <br /> D unit 6 <br /> Specific Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> MUNDERGROUND TANK(UST)CLEANUP SITE(LOP) []DOUSING ABATEMENT <br /> OTHER CLEANUP SITE ON LOA Ll SOLID WASTE FACfLITYNEHICLE <br /> N <br /> ( ) ©FOOD FACILITY ❑WASTE TIRE <br /> UNDFNGROUNo TANK(MONITORING/REMOVAL) ❑DOG KENNLL <br /> HAZARDOUS WASTE GENERATOR ❑DAIRY <br /> ❑CHICKEN RANCH <br /> ❑TIERED Pt RM1TfEO FACILITY MOTELIHOTEL WASTEWATER TREATMENT PLANT <br /> ❑TATTOOIBODY PIERCING ❑PUMPER TRUCK(YARDICHEMICAL TOILETS <br /> ❑ <br /> ❑POOL/SPA ❑LAND USE APPLICATION SITES MEDICAL WASTE FACILfTY ❑COMPLAINT RECORDS ❑OTHER(PLEA8E SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAfLA13LE FOR REVIEW: MONDAY-FII" 846 AM-5;00PM EXCLUDING HOLIDAYS) <br /> 1. List u to tan a seas In the space above. Select the f e s of flies from file list above b checking theappropriate <br /> box(es). At faast one file yp { ) Y Sabove. <br /> ranges will not be accepted-for addittiional assist n e with 0fi!aadreseosr contacmail to t he EHO.SAppll ationss Indicated receiv ddafter$ <br /> 3:00 pm will be processod 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 offive busineats days for TOVlew. Appointments <br /> to should be scheduled accordingly. <br /> 3. A fife 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 tile same condition as released will be reorganized by EHD staff at the expense of the applicant.' <br /> FVture file reviews by the some applicant may require a$125 deposit prior to revlew. <br /> 4,2 <br /> i <br /> EHo 46-CO <br /> alit ! <br />