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`.w `■r11 <br /> REGVE D SAN JOAQUIN COUNTY EHD LOG M ER <br /> NOV 15 2010 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.Sjgov.org/e <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: (I 't i� e Il C(It BUSINESS/AGENCY: G L- ' <br /> ADDRESS: �rKrC{ �. S��i� �� Q CITY/STATE/ZIP: S <br /> PHONE(1); 1 - � � u3 <br /> E-� ��PHONE(2)_ -� 5 - rj�9 J FACSIMILE: �� rj- `>q -] U <br /> TENTATIVE'APPOINTMENT DATE: <br /> (Please allow 10 business days from date of application submittal-`Tentative only-must be canf'irmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST;$122 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 313USINESS DAYS <br /> SIGNATURE OF APPLICANT-(IX46 S11- DATE f ( {' <br /> Electronic Information: ❑List❑Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street# Street Name <br /> Ci�ty-1_ <br /> 1. To NA ( t t� ��-- -- -- Unit1 <br /> 2. f'a <br /> 3. - �. — Unit 2 <br /> 4. N tl <br /> 5. Unit 3 <br /> 6. <br /> 7. 144- <br /> 9. Unit 5 <br /> 10. ' <br /> Unit 6 <br /> Specific Date Range of Information Requested: From o L—L <br /> amu' ENVIRONMENTAL HEALTT DEPARTMENT FILES to <br /> �UNDERGROUND TANK(UST)CLEANUP SITE(LOP) �(OUSING AOATEMENT [OLID WASTE FACILITYNEHICLE <br /> CJ OTHER CLEANUP SITE(NON-LOP) GfOOD FACILITY OVASTE TIRE <br /> E21UNDERGROUND TANK(MONITORING/REMOVAL) Q6OG KENNEL ['DAIRY <br /> rDr-•�,fl�AZARDOUS WASTE GENERATOR D-CHICKEN RANCH <br /> Lid"�IEREO PERMITTED FACILITY I�'t� [ti�'WASTEUVATER TREATMENT PLANT <br /> r-�' [�MOTELIHOTEL Q"PUMPER TRUCKIYARDICHEMICAL TOILETS <br /> LJ'TATTO0/BODY PIERCING Q POOLISPA <br /> MEDICAL WASTE FACILITYOTHER(PLEASE SPECIFY) DUND USE APPLICATION SITES <br /> ❑ <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 /> box(es), At least one file type MUST be selected. Fax to(2D91464-0138 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$122 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 48-06 <br /> 07129110 <br /> Z'd 098L-L69-96b e01B0i0eE) deq:Zo 06 96 AON <br />