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04/12/2012 12:45 FAX Z001/001 <br /> DATE RECEIVI=p EHD LOG NUMBER <br /> RECEIVEDENVIRONMENTAL HEALTH DEPARTEEI E COP <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> 2 7011- Telephone: (209) 468-3420 Fax: (209)464-0138 Web: WWW.sjgov,org/ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: V_ 4e-y— ;Fu' I�3 BUSINESSIAGENCY: Cr�-V_7-ori <br /> ADDRESS: `Z `� G CITY/STATE/ZIP: t✓t�t�t[y 32.) <br /> PHONE(1): ffl2) p60-02,S'-y PHONE (2): (6 {� v�� FACSIMILE: R(6 —040 3 <br /> TEN7'A APPOINTMENT DATE' ( ZoI 'Z Time: Ll &tom <br /> (Please allow 10 business days from dat of appllcaUon submittal-'Tonrattve only-muet be confirmed) <br /> CHECK BOX TO EXPEOITE REQUEST- 5 FEE HO ECK ONLY)-REQUEST PROCESSED IN 3r BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE�-I <br /> Electronic Information: ❑ List❑ Map-Description; <br /> FILE ADDRESS EHD USE ONLY <br /> Street N Street Name City (� Ej Unit 1 <br /> VjT <br /> 2. S:�-O0 CE'4 tl�lA �?"T7 Un1t2 <br /> 3. ?_bOo <br /> 4. ,.Zfunit 3 ; <br /> 3017— 5, Et- <br /> 6. <br /> Ot�2DtUo i 57oc�-I�r l I n <br /> �� �.1- �-�qcc <br /> r8.7. <br /> Unit 5 <br /> 9. „��13) <br /> 1� I 0/upit's <br /> I E. Ei <br /> Specific Date Range of Information R*quested; From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE5 <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT SOLID WASTE FACILITYNEHI LE <br /> OTHER CLEANUP SITE(NON-LOP) Q 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 TRUCKNARD/CHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE FACILITY ❑COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM•5:00PM(EXCLUDING HOUDAYS) <br /> 1. List up to ten addresses in the apace above. Select the type(s)of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. FaX (2091464-0138 or mail to the addreg* Ica ve. 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 busineas day. <br /> 2. The EHD will notify the applicant if any EHD files 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 /> a. Any file not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant_ <br /> I Future file reviews by the same applicant may require a$125 deposit prior to review. <br /> EI ID USF ONLY <br /> i <br /> i <br /> I <br /> 8Htt1 <br /> EHD 48.08 <br />