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05/08/2009 11:25 70774831Z� PAGE 01/01 <br /> Dt""Nt- =' SAN JOA,QUIN COUNTY EHD LOG NUMBER <br /> MAT 2009 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA.95202-3029 <br /> ENVIRONMENT HEALT4 Iepboae:(209)468-3420 Fax:(209)464-0138 Web:www.9jgov.o <br /> PERMIT/SERVICES PLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: tit,C- ,.. ?A..TZ BUSINESSIAGENCY: (zeOFS 4SsoC( TIS <br /> ADDRESS: 7 I�I Wj� 1'�C'� SO eT e -ZO2CA Aq5 ( 0 � r, <br /> PHONE(1): C7 PHONE(2): FACSIMILE: 707 f"l �Y s � 7D <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of applicaV "Ittal-"TeRtetive only-must be confirmed) <br /> d CHECK BOX TO Expl=niTE REQU T $ F (C .''i-REQUEST PROCESSED iN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT —DATE Lo <br /> Electronic Infonnation: []-List –Description: <br /> FiLE ADDRESS _HD USE ONLY <br /> street III Street Name C ❑ Unit 1 <br /> F2. ❑ Unit 2 <br /> 3. <br /> 4. nit 2 <br /> 5. <br /> 6. 0*4 <br /> 7. <br /> 8. ❑ units <br /> 0. Unit 8 <br /> � Specfic Date flange of Information Requested:FromULt. <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> ' 1DmmmX NO TANK(UST)CLEANUP SITE(LOP) ©HOUSING ABATEMENT S"WASTE FACILITYIVEHICLE <br /> XXOTMR CLEANUP SITE(NON-LOP) O F000 FAciuTY 8WASTE TiRE <br /> UWDERGROUNDTANK 1MONITORINGIREMOYAL) 0 DOG KENNEL ❑DAIRY <br /> 1 HA=AROOUS WASTE GENETtATOR r3 CHICKEN RANCH t3 WASTEWATER TREATMENT PLANT <br /> PEipknM FACnAV G NIOTIR/HO' IL 0 PuMPER TmicKiYARDICHEm To1LET8 <br /> .'"�13 TATToolgoDY PIERCING- 0 P000SPA a LAND USE APPLICATION Sates <br /> icAU WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SSMC POWIT RECORDS ARE AVAILABLE FOR Ft&MEW- MONODY-FR10AY 8:00 AM-5:00PM - EXCLUD G;H Ys. <br /> 1. ten addresses in,the space above. Select the type(*)of files from the list above by Chookr the appropriate <br /> box(es). A Tgast-ona#da_typt-►MUST be selected. Fax to(209141114-0138 or mail gag addmKIndlcated above Address <br /> ranges will not ba accepted-for addhl•nff-4 F aA with file addrM4 �Cor ct 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 files exist. An appobrtmant for review will be confirmed approximately ton(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 adcordineiy. <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 /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expanse 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 /> �e aoW49 SAW= <br />