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FT <br /> F K I E 488 268 8527 Mar. 20 2011 05:48AN P1 <br /> _. <br /> RECE <br /> DATE RECE=IVED E EHD LOG NUMBER <br /> SAID JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT �( <br /> ENVinONMEN-AL H 600 East Main St. Stockton, CA 85202-3029 ' <br /> PERMIT/SEI�I/lOE 4Mphlone: (209) 468-3420 Fax:(209) 464-0138 Web: www.sjgov.Org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: 13USINESSIAGENCY:_ <br /> ADDRESS: t� w., CITYISTATEZIP:�Lnrll q530 <br /> PHONE(1): Q_7 _ PHONE(2)• FACSIMILE: <br /> TENTATIVE'APPOINTMENT DATE'. Time: I I (}}r C1 <br /> (Please allow 16 business days from data of ap ication subrnittal-*Tentative only•must be confirmed) <br /> [CHECK 130X TO EXPEDITE REQVFST-$122 FSE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS GAYS <br /> SIGNATURE OF APPLICANT GATE L <br /> Electronic Information: NrList❑ Map—Description: <br /> FILE ADDRESS EH13 USE ONLY <br /> Street# Street Name city Unit 1 <br /> 2_ r ❑1lnit 2 <br /> 4. <br /> sem ' Unit 4 <br /> 7. <br /> 8. ❑units <br /> 10. Unit 6 <br /> Specific Date Range of Intormatian Requested* From to <br /> ENVIRONMENTAL HEALTH DEIPARTMENT F <br /> !_l a DER13ROUND TANp0LIST)CLEANUP SITE(LOP) ❑HOUSING ABATEMIZUT OLID WASTE FACIL"IVEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> [�4NDERGROUND TANK(MONITORINWREmovAL) ❑DOG KENNEL ❑DAiRy <br /> QrHDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> IERED PERI Fum FACILITY ❑MOTELIHOTEL ❑Pummz TRUCKIYARDICHEMICAL TOILETS <br /> �]TATTOQIBODY PIERCING �POOLISPA ❑LAND USE APPLICATION SITES <br /> MEDICAL WASTE~FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS AfRE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. List up tp ten address in the space above. Select the types)of files from the list above by checking the appropriate <br /> box(es). At lea$t one file type MUST be selected. Fax to(249)464-0996 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 /> 3:40 pm will be processed the next businessday. <br /> 2, The EHD will notify the applicant if any EHD files exist. An appointment for mviesw will be confirmed approximately ten(90) <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 FHq 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 sante condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may roquire a$122 deposit prior to review_ <br /> EHD USE ONLY <br />