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04/12/2012 12 : 45 FAX [2001/001 <br /> DATE RECEIVED EHD LOG NUMBER <br /> SAN JOAQUIN COUNTY <br /> RECEIVEDENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, Cr8itl4*1 �j � ��17 Telephone: (209) 468-3420 Fax: (2p9) 464-0 /ehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: VA,V(-- EbI �3 BUSINESS/AGENCY: Cp��P-C_rn S; IG* �►� L <br /> ADDRESS: W ? t✓ CITY/STATE/ZIP: CA c�'5_621 <br /> PHONE (1): p -�7.3`� PHONE(2): (6 g 1-9 FACSIMILE: <br /> TEN TIVE'APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dat of application submittal-'Tentative only-must be confirmed) <br /> FS CHECK BOX TO EXPEDITE REQUEST- 5 FEE H OR ECK ONLY)-REQUEST PROOE$$ED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DATE <br /> Electronic Information! ❑List 0 Map-Description: <br /> FILE ADDRESS FHD USE ONLY <br /> Street X Street Name City L]Unit 1 <br /> 1. ?Soo C.A_l 1 , l_vt'A0Z� <br /> 2. 2.�-O0 Ai~OR-l�lA �TUnit 2 <br /> 4. ZgC� �• C�i��AU-a 5 I. STbc� unit s / <br /> [7. /S• ��P-L�C�c S i S t {L^ U - 17 Cti:(�vin Unit 4 Unit 5 U e <br /> SpocKic Date Range of information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNOERGROUND 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 TRUcKNARDICHEMK AL TOILETS <br /> TATTOO/BODY PIERCING ❑POOLISPA ❑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 HOLIDAYS) <br /> 1. List up to ton 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 file type MUST be selected. F 209 13B or mail to the address1 e. Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. Applications received after <br /> 3:00 pm will be processed the next business 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 avallable 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 expense of the applicant_ <br /> Future file reviews by the same applicant may require a 512E deposit prior to review. <br /> EI ID USE ONLY <br /> I <br /> -em M1 <br /> Eµ0 48.06 <br />