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ALIg 14 U1 l U:U 1p 10M 7149687509 P.1 f <br /> rb) !� EMD LOG NUMBER <br /> l� "ME V. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPART <br /> i91 if; 2007 600 East Main Street,Stockton, CA 95202-3 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:v«v <br /> ENVIRONMENT HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICAT.IQN <br /> APPLICANT: SUSINESSIAGENCY: +-tC -d r� <br /> ADDRESS: G StCAr Gf! r 1 54 ELI <br /> 19 bra <br /> PHONE(1): OZ 0 OD PHONE(z}: FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from date of application submittal-'Tentadiye only-must be confirmed) <br /> ❑ <br /> CHECK BOX Ti)EXPEDITE CASH OR HECK ONLY}-REQUEST pROGESSED IN 3 U51N 55 DAYS <br /> SIGNATURE OF APPLICA DATE <br /> Electronic Information: ❑Li Map- Description:. <br /> FILE ADDRESS EHD USE ONLY <br /> Street 0 Street Mame City Unit 1 <br /> 2, ❑ Unit 2 <br /> 3. d& \. <br /> 4. Unit 3 J� <br /> 6.. 5� <br /> -n <br /> h Y <br /> 7. <br /> �• ❑ Unit 5 <br /> 10. ❑ Unit 6 <br /> Specific Date Range of Information Requested:From <br /> EI VIRONMENTAL HEALTH DEPARTMENT FILES <br /> - 'ONAERCROUNDTANK(UST)CLEMUPSITE(LOP) 0HOUSINGABATEMENT - 0SOLID WASTEFACILMYNEHICLE <br /> J0 ETHER CLEANUP SITE(NoN.LOP) 0 FOOD FACILnY 0 WASTE TIRE <br /> -SaTINDMOROUND TANK 090NITORINCIREMOVAL) D DOG KENNEL O DAIRY <br /> Zkg4MOGUS WASTE GEN EAATOA 0 CHICKEN RANCH ❑WASTEWATER TREAMENT PLANT <br /> J2rT[ERED PEWI[TTED FACILrrY 0 MOTEUHoTEL CI puMPER TRUCKIYARWCHEm TOILETS, <br /> d TATT00I1300Y PIERCING Q PDDLlSPA b. <br /> LAND U s E APPLICATION SITES <br /> 13 MEMCAL WASTE FACrLITY ❑OTkWR(PLEASE S PECIFY) . <br /> WELL ANDS EPM PER C - <br /> MITRE aROSAREAVA[LABLEFORRSVIEW-MONDAYfR[DAY13:1)OAIir�:00PN1 -ExCLUDINGHOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the 6W.(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 aceeptpd—for additional assistance with rile addresses,contact the EHD.Applications received after <br /> 1,00 pm will be processed the next business day, <br /> 2. The EHD will notify the applicant If any END fifes 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 rive business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3< A file that Is actively being worked on by EHO staff may not be Immediately available for review, Anew application may be <br /> submitted when the Tile Is available. <br /> 4. Any file not returned In the some 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$95.D0 deposit prior to review, <br /> EHD USE16NLY' <br /> EKDArasrvES ar 2W? <br /> i <br />