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EHD LOG NUMBER <br /> It v SAN .10AQUIN COUNTY <br /> AVk 2 1 2009 ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 600 Past Main Street, Stockton, CA 95202-3029 <br /> UWIRMMENT.HEALWephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sjgov.o <br /> PERMITISERMCE3 PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: N D t BUSINESSIAGENCY: F_ky-3r-0 <br /> ADDRESS: SO IV. W� ,I�/I�ma, AVP. Jfe A City/Statelzip <br /> PHONE(1): ZDq �� .7'10L.r7 PHONE(A2):: .VA_ ZZI - 2ro&f, <br /> —FACSIMILE: - - <br /> TENTATIVE"APPOINTMENT DATE. Moret. S', Time: a,3o AjL" <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be confirmed) <br /> 171 CHECK BOX TO EXPEDITE RE T- 0 EE(CASH OR CHECK ONLY).REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT / DATE •Z! <br /> Electronic Information: ❑List❑Map–Description: <br /> _ FILE ADDRESS EHD USE ONLY <br /> Street# Street Name City _.-._..._.,.......-.--- Q <br /> Unit'! <br /> 1- b C Q_ -} ,0,o'__ <br /> 2. W.:7(QST /uQ 2Ca' _.�..,., q<- 6 tiIc� (� Unit 2 <br /> M 0- Ava <br /> a sao a ' unit 3k <br /> 9s6)..: <br /> nit <br /> • .2 n M F - - 5d <br /> L q — ajA <br /> • Unit S <br /> a a9 0 QIv .. c,� a <br /> h---St 0 Unit 6 <br /> 10. etd i n o s.• - <br /> Specific Date Range of Information Requested:From C&rlleI-) to r4e,4 <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> 1 UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYNEHICLE <br /> OLOTHER CLEANUP SITE(NON-LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> P�,�{�{'U''' E <br /> NOERGROuND TANK(MONITORING/RMOVAL) 0 Don KENNEL C)DAIRY <br /> x-HAZARDOUS WASTE GENERATOR 0 CHICKEN RANCH Ci WA5TEWATER TREATMENT PLANT <br /> O TIERED PERMITTED FACILITY CI MOTELIHOTEL ❑PUMPER TRUCK/YARD/CHEM TOILETS <br /> 0 TATT00/Bow PIERCING ©POOL/SPA CI LAND USE APPLICATION SITES <br /> C7 MEDICAL WASTE FACILITY 0 OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY-FRIDAY 8:00 AM-5:00PM - EXCLUDING HOLIDAYS. <br /> 1. List up to ten addresses in the space above. Select the type(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 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$105 deposit prior to review. <br /> EHD USE ONLY <br /> END 48-06 6/04/08 PUBLIC RECORDS RELEASE APP FORM <br /> EO/T0"d 6620 998 SES T Q311J'10d�i00NI 030N3 22:9ti 600E-TE-ddd <br />