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{gtpy � <br /> E7KIE ' ,- 40B 268 8627 7 1 Mar. 28 2011 05:40RM P1 <br /> EHD LOG NUMBER <br /> DATE RECEIVED SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT ( <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> ENVIRONMENTAL HEL�II ` 1 <br /> PERMIT/SERVICE (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT �{� BUSINESSIAGENCY:__ rn ryGI <br /> ADDRESS: ACITY/STATEIZIP: j-, I{ 1 1 GL j <br /> PHONE (1): � PHONE(2) FACSIMILE,A( IM Rlo7� <br /> TENTATIVE'APPOINTMENT PHONE <br /> f�_1 Time: (I a (�p0 <br /> (Please allow 10 business days from dam of application submittal-*Tentative only-must be confirmed) <br /> CHECK BOX TO EXPEDITE REQUEST-9122 EEE(CASH OR.CHECK <br /> � O�NLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF '1 APPLICANT I l,�(C1( F Y ��((i.( PDATE <br /> Electronic Information: [List❑ Map—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> I <br /> Street Street Nam Cay _ Unit <br /> 2. ' ❑Unit 2 <br /> _ � I <br /> 3. <br /> UnR <br /> 4. <br /> 5 _ 3 <br /> _ �Z <br /> 7 <br /> 9. <br /> 10. Unit 6 <br /> Specific Date Range of Information Requested: Fromto (-Al f' <br /> ENVIRONMENTAL HEAL H D P RT llT IF 19f <br /> DERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT L9SOLID WASTE FACRffYIVEHICLE <br /> r THER CLEANUP SHE(NON-LOP) ❑FOOD FACILITY ❑WASTE TIRE <br /> &0DFRGROUND TANK(MONITORINGIREMovAL) ❑DOG KENNEL ❑DAIRY <br /> UvHAZARDOUS WASTE GENERATOR -❑CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> ,_ <br /> IERED PERI fh ED FACILITY ❑MOTEIJHOTEL - ❑PUMPER TRUCKNARDICHEMICAL TOILETS <br /> Q TATTOo/BODY PIERCING - ❑POOLJSPA ❑LAND USE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY$:00 AM-5:00Pfd(EXCLUDING HOLIDAYS) <br /> 1. List up tq ten addresses in the space above. Select the type(s)of Rtes from the list above by checking the appropriate „ <br /> bnx(es). At least one file type MUST be selected. Fax to(209)464-0190 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 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 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$122 deposit prior to review. <br /> atlb uss rxxr <br /> I <br /> I <br />