Laserfiche WebLink
i 11- 4-09; 7:39AM;Dept of Conservation ;916 322 4862 $t 1� 1 <br /> i <br /> HITT <br /> I I,,{ ( [? EJ/��I }} W EHD LOG NUMBER <br /> 11 U U fill LLL���f_:./ SAN JQAQUIN COUNTY <br /> f �V z�09 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202.3029 <br /> ENVIRUNMENTHEALAIIephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/e <br /> PERMIT(SERVICES PUBLIC RECORDS RELEASE APPL1CATl t f <br /> 0. <br /> APPLICANT: o�tc� or' <br /> 6dw i M2AJS tjy BUSINESS/AGENCY: .Qr�'T"al (p,J 6ni/Y} _ M^ <br /> ADDRESS: '80I 14, 511 PAS 01-0( CITY/STATE/ZIP: AZA4,mC^jt*i U4 <br /> PHONE(1): 6)16 - 3-2-Y 06Gj PHONE(2); (S- 14 CrY-3 FACSIMILE: /6 32-Z q6 <br /> TENTATIVE'APPOINTMENT DATE: /UOV6W cc4 ry, aq Time: LD <br /> (Please allow 10 business days from dale of eppficatfon submittal-*Tentative only-must be confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$11 FEEz C SH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSMESS DAYS <br /> SIGNATURE OF APPLICANT —- DATE <br /> Electronic Information: ❑ List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Name City ❑Unit 1 <br /> C' <br /> 2. W-9 to —01 <br /> ' 3 <br /> P 4. /4 <br /> F ❑Unit 3 <br /> I 5. <br /> t 6_ <br /> f Unit 4 <br /> 7 7. <br /> ❑Unit S <br /> L190. <br /> []Units <br /> Specific Date Range of Information Requested: From __ 9 9(d to 2co 9 <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES W <br /> ❑UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACiLITYNEHICLE <br /> ❑OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> ❑UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOTELIHOTEL ❑PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑TATTOOIBODY PIERCING ❑POOLISPA LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) Q X--Q(p— D( <br /> WELL AND SEP'fic PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:40PM(EXCLUDING HOLIDAYS) <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 /> pox(es). At least one file type MUST be selected. Fax to 209 464-0138 or mail to the address indicated above. Address - <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. 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 /> t 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. e <br /> t Future file reviews by the same applicant may require a$115 deposit prior to review. <br /> N5. If you need further assistance,please contact Diane Martinez,at(209)468-3425. <br /> fI. EHO ME ONLY <br /> E <br /> 3 <br /> { <br /> 9 EHd 4E-06 <br /> t 6!27!69 <br /> 9 <br /> 1 <br /> 3 <br />