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R E SAN JOAQUIN COUNTY EHDLOG MER <br /> NOV 16 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sigov.org/e <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES - PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: D(lV�a DR I �liCi2 BUSINESS/AGENCY: (5-�C)(C� iC <br /> ADDRESS: 5i f CI SI P 9 n <br /> _ CITY/STATEfZIP: San Fa„ c sCc) CA 84103 <br /> PHONE(1): 115j-59 F_�FC3 PHONE(2): 90 :� - 75- 5'99 1 FACSIMILE. J �j- >Cj -7�gO <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from tlate of application submdtal-•Tentative and Time: <br /> El y.must be conFlrmed) <br /> CHECK BOX TO EXPEDITE RE�QQU-��E99ST-$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT 1 �J /9 hl n <br /> DATE <br /> Electronic Information: El List E] Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> City <br /> �• Unitl <br /> 4. <br /> 5• UnR 3 <br /> 6. <br /> 7. <br /> 8. <br /> 9• Units <br /> 10. <br /> Specific Date Range of Information Requested: From �� Unit fi <br /> ENVIRONMENTAL HEALTH DE ARTMENT FILES to <br /> E21INDERGROUND TANK(USI)CLEANUP SITE LOP rr���� <br /> (LOP) La'F10USING ABATEMENT LTJOUD WASTE FACIUTYNFHICLE <br /> DOTTER CLEANUP SITE(NON-LOP) rQ�'F000 FACILITY <br /> [ UNDERGROUND TANK(MONITORING/REMOVAL) LJ KENNEL Ca'WASTE TIRE <br /> 9f-IAZARDDUS WASTE GENERATOR [.}CHICKEN RANCH eI�J)AIRY <br /> ['TIERED PERMTRED FACILITY DICHI KENR N La WASTEWATER TREATMENT PLANT <br /> Q PUMPER TRUCKIYARO(CHEMICAL TOILETS <br /> aTATTOo/BODY PIERCING <br /> D❑ PA <br /> 9401Eo1CAL WASTE FACILITY OTHER(PLEASE SPECIFY) Eg'WD USE APPLICATION SITES <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. list uD to ten addresses in the space above. Select the type(s)of files from the list above by checking the appropriate <br /> b OX(es). At least one file type MUST be selected. Fax (2091464-0138 or mail to the address indicated above Address <br /> ranges will not be accepted-for additional assistance with fUe atldresses,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 /> EHD USE ONLY <br /> EHD 4a-CN <br /> tolzvto <br /> Z 099L-L69-9t7 80160090 d�q:ZO Ol SI, ADN <br />