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04/12/2012 12 45 FAX fa001/001 <br /> DATE RECEIVFD ' EHD LOG NUMBER <br /> SAN .JOAQUIN COUNTY <br /> RECEIVED ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St, Stockton, CA 95=-3029 <br /> 12 2012 Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.orglehd <br /> ENVIRONMENTAL HEALTH , <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: E BUSINESSIAGENCY: f� P-- rJ �lfr.�' �.i.!L <br /> ADDRESS: ` t✓ CITYISTATEIZIP: CA `- T62.) <br /> PHONE(1): -023`f PHONE (2). ~ �& FACSIMILE: 4 r- –04'03 <br /> TEN —VL*APPOINTMENT DAT ( 2oP �L Time: Gi <br /> (Please allow 10 buaineas days from da of aplillcatlan submittal--TentatNe oniy-must bo.conflrmsd) <br /> IN-2, EC O-EXPEO3TE'REOUEST-. 5,FE H OR ECF(ONEY,)'=-RFOUEST PR,DGESSEb IN 3�BUSINESS-QAYS.,. <br /> +w^a r1.rx,o � '..w�$+ I�r� <br /> SIGNATURE OF APPLICANT DATE Tt{ <br /> Electronic Information: ❑ List❑ Map—Description; I" <br /> FILE ADDRESS EhD USE ONLY <br /> 8trrst k Street Name City Unit 1 <br /> ?goo S. Cil <br /> FS400C111p1 F CST .-I Unit <br /> C�Lt�. E D1� 4 S!. � sUnit s <br /> - Unkli <br /> SWtfic Date Range of Infutma11on Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILR YIVEHICLE <br /> OTHER CLEANUP SITE(NON-LOA) [I FOOD FACILITY R WASTE TIRE <br /> UNDERGROUND TANK(MONITORiNGIREMOVAL) ❑DOG KENNEL E]DAIRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL Ej PUMPER TRUCKNAROICHEMICAL TOILETS <br /> TATTOOMODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATioN Sim <br /> MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAiL.ABLE FOR REViEW: MONDAY-FRIDAY$:00 AM•5.00PM ExCLUDING HounAYS) <br /> 1. List up to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one 1110 type MUST be selected. FAX 209 464-0138 0 ! ll to",the address1 e. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3.04 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any EHD tiles 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 buslhess days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fila that is actively being worked on by EHD staff may not be Immediately avallable for review. Anew 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 fila review$by the same applicant may require a$125 deposit prior to review. <br /> EI ID USF CNLY <br /> j eon+ <br /> EIiD 48-06 - <br />