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lt�) <br /> E <br /> ��f���f J���IV£D SAN JOAQUIIV COUNTY EHD LOU NUMBER <br /> IlJ�ryyli L4 +1 L�� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 2��Q 600 East Main St.Stockton,CA 95202-3029 <br /> FE8 1 Telephone:(209)468-3420 Fax:1209)464-0138 Web:www_Sj9nV.org/eh F1031)0 <br /> EW41ROWOENT HPAITH 1PU\BLIC RECORDS RELEASE APPLICATION <br /> PERMITISERVIGaICANT:__ C1�/ ti� BUSINESS/AGENCY:1ij'tYer.(Q-(_l-rvf <br /> ADDRESS: j (1d ll/(OKro+ S}fotd rzt : /3�L0 <br /> PHONE(1): Yllli k y- 5 21P PHONE(2): 1 h y0 - Y'1 S-6 FACSIMILE: 01 7 C'1 Y- S�2O <br /> TENTATIVE`APPOINTMENTDATE: �)241112 (errorf.rL 18CAlt) Time:10;d'p LQM <br /> JPlooso allow 10 business days from dato of application sobmhtal-'Tontsrlva only-must bo Confirmed) <br /> ❑CHECK EO%Tp ExPEOnE REOUES $115 FEE(GASH OR CHECK 01,14Y)-REOUI:51 PROCESSED IN 3IIySIN�jSS DAYS <br /> SIGNATURE OF APPLICANT DATE: a 1lAflD <br /> Elottronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street/ Street Name .., City ❑Unh t <br /> 1. Wet l „E.ad 4l-.,P' ke"d TfOtC-Z(...... <br /> 2. 2-Pka__ k►v �7rryy�.�'..S„�vr RQ:.C� ... .. ❑Unit 2 <br /> 3. Zjv'�T <br /> 4. _. — unit CA <br /> 6. aIYvLrnllI <br /> r. zgL,0 <br /> _.. .......... _. <br /> .. _ <br /> 8. 1� d <br /> 9. Z q(I.. <br /> 10. 30!QT unit S <br /> Speclflc Date RonOa of Information Requested: From to <br /> ENVIRONMENTAL.HEALTH DEPARTMENT FILES <br /> ❑UNDERGROUND TANK(UST)CLEANUP SO L(LOP) F-IrHOUSING ABATEME14T Il S0100 WASTE FACILIIYNEIiICLE <br /> -roTHER CLEANUP SITE(NDN-LOP) 0 1:000 FACILITY ❑WASTE TIRE <br /> ©UNUEkGROUNDTAW(MOMIORINGIRfMOYAL) (—II)OGKENNEL [:1 DAIRY <br /> ❑HAI.ARDOUS WASTE GENERATOR I,.I CHICKEN RANCH WASTEWATEk TREA1MEN IPLAN1 <br /> ❑TIERED PERMITTEDFACILITY f MOTELMOTEL ❑PUMPER TRUCKNANINCHEMtCALTOILETS <br /> D TATroalSooY PIERCING ❑POOUSPA ❑LAND USE APPLICATION SifES <br /> ❑MEDtCA]WASTE FACILITY C 01 HER(PLEASETY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:DO AM-5:0DPM ExrLUDING HOLIDAYS) <br /> 1. Lig ma to ton addresses In The space above. Select the type(s)of filen from the Kit above by checking the appropriate <br /> boxlasl. At least one filo type MUST be selec(od. FaL 9011)464.0138 or mall to the,gdgLpp Indloatod 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 preeoosed the nod business day. <br /> 2. The EHD will notify the applicant H any EHD fllos oxisL An appointment for review will be Confirmed approximately ten 110) <br /> days after receipt of application. The flies will be hold for s maximum of Nva business days for review. Appointments <br /> should be scheduled accordingly. <br /> 3. A file that Is actively being worked on by EHD staff may net be immadlatoly avallable for review. A now application may he <br /> submitted when the file Is available. <br /> 4. Ally fila not returned In the same eendIt on as released will be reorganized by EMD staff at the expense of thn applicant. <br /> Future file reviews by the same applicant may require a$115 daposlt prior to review. <br /> S. H you need further assistance.please contact Diane Martinez,at(200)X08.3425. <br /> CHO Lae ONLY <br /> T 1'2 8£T0b9b502:01 op2st'286Ttl N061nN3 25:ST 0102-OT-e33 <br />