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RECEIVED916KIn177 APEX ENVIROTEC PAGE 02/02 <br /> PATEE RECEIVED � <br /> f; Q � Z011 SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main St. Stockton, CA 95202-.3029 <br /> PERMIT/SERVICES Telephone: 209 468-3420 Fax: 209 464-0 <br /> ( ) ( ) 13$ Web: www.$)gov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: IoM BUSINESS/AGENCY: A ext FAV?-0 <br /> ADDRESS: I a�� (� rii>?�S CITY/STATE/ZIP: _�c� w <br /> PHONE(1): 8S)- I 1 HONE (2): p- vn— [69 FACSIMILE: b -85(-0)-7 7 _ <br /> TENTATIVE*APPOINTMENT DATE: 51 1� Qot 1 Time:�.� D� ✓}/V} <br /> (Please allow 10 business days from date of application submittal-"Tentative Only-must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQU T-$122 FEE(CASH 0R CHECK eNLY)-REQUEST PROCESSED IN 3 BUSINESS[DAYS <br /> SIGNATURE OF APPLICANT DATE sl�l.Z*,it <br /> Electronic Information: [] List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City Unit 1 <br /> 1. 5L4 I F <br /> 2. - <br /> F,unit 2 <br /> 3. <br /> 4. 1 <br /> nit 3 <br /> 5. <br /> 6. <br /> Unit 4 <br /> 7. <br /> $ ❑Unit 5 <br /> 9. <br /> 10. <br /> �Unit <br /> Specific Date Range of information Requested: From to <br /> 9L-O?'* ISS- ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ❑SOLID WASTE FACILITYIVEHiCLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ©DAIRY <br /> ❑HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TkEATMENT PLANT <br /> CI TIERED PERMITTED FACILITY 0 MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR RIkVIEW: MONDAY-FRIDAY 8:00 AMZ:OOPM(EXCLUDING HOLIDAYS) <br /> 1. List un 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)4134-0138 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 tan(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 /> 4. Any file not returned in the same condttlon 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$122 deposit prior to review. <br /> EHD USE ONLY <br /> t6.D8 07120/10 <br />