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67/29/2011 12: 19 916E 688 m6DFA PAGE 01/01 <br /> RECENED SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> IUL 9 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 CP <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> ENVPERMIHEALTH <br /> T SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: ��,yy BUSINESS/AGENCY: /'"1111& <br /> ADDRESS: 2_' 5 � � ' -t�� City1$ttdt /zip - 9!S_8 <br /> PHONE <br /> `7 <br /> PHONE(1): 916- 0 3`JOr PHONE(2): �+ 1. � FACSIMILE: 1516-c"q <br /> TENTATIVE"APPOINTMENT DATE: 2 O 11 Time: d.loo p M <br /> (Please allow 10 business days from date of application submittal-'Tenfaflve only-must he confirmed) <br /> CHECK BOX TO EXPEDITE REQ,""'T-$105 FE ( ASH OR CHECK ONLY)-REQUEST PROCESSED IN,3 BUST ESS DAYS <br /> SIGNATURE OF APPLICANT ti/�-�-- cDATE <br /> Electronic Information- ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Strset Name City <br /> 1. ' �����v� ❑ Unit 1 <br /> 2. 01 • e °�1F". \V ElUnit 2 <br /> _ F � <br /> 3. <br /> 4. <br /> 1 I El-Unit 3 <br /> r7. <br /> Unit 4 <br /> ElUnit5 <br /> . <br /> 9. <br /> unit 6 <br /> Specific Date Range of Information Requested:From ��� to � <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) HOUSING ABATEMENT X$OL,ID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 171WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) 0 000 KrNNEL ❑DAIRY <br /> HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH 0 WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY 11 MOTEL/HOTEL 0 PUMPER TRUCKIYARDICHEM TOILETS <br /> TATTOO/BODY PIERCING 13 POOLISPA ❑LAND USE APPLICATION SITES <br /> !]MEDICAL WASTE FACILITY El OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORPB ARe AVAILAOLH FOR REVIEW-MONDAY-FRIDAY 8!00 AM•6:00PM - 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 /> box(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 files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The files will be held fora maximum of five bualness days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A fl)e 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 expense of the applicant. <br /> Future file reviews by the same applicant may require a$105 deposit prior to review. <br /> EHD USE ONLY <br /> EHD 48-06 0104108 PUBLIC RECORDS RELEASL APP FORM <br />