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TO ICA 114101 • <br /> �l.)@IC7�CV�Ir-'� EHD LOG NUMBER <br /> DAT <br /> SAN JOAQUIN COUNTY <br /> F"E9 2 7 2008 ENVIRONMENTAL HEALTH OEPARTMEN tl� <br /> 600 East Main Strect, Stockton, CA 95202-30293chd <br /> I <br /> HF.�ohone: (209)468-3420 Fax: (209)464-0138 Web; wwwsj ov.or <br /> PF;;u fi)I'Fr^c�lrirc <br /> _ GY PUBLICRECORDS RELEASE APP <br /> , LICA I10N <br /> _ APPLICANT: 5 h -1r-r J l4 BuSINESSSIAGENfCY: 7-N S R' <br /> ADDRESS:3 Q b ( -C&M 1 12r '� v <br /> Zp 0 tcUQ, d, C h t't �4tO �Z ��1T ,Ati�t <br /> PHONE(1);F1L -!6Sb^R(:i764,,. PHONE(2):tS10 22ts 4§1 FACSIMILE:610 —�6SO^--LC1`Zd3 <br /> TENTATIVE*APPOINTMENT DATE: Time: <br /> (Please allow 10 business days from dat�"of-'a`pplioation submittal•`Tentative only-must be confirmed) <br /> 13 CHECK BOX TO EXPEDITE REQUEST-$95.00 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANTt? S Li 1�0Qv - DATE ca�. <br /> Electronic information: [K List© Map-Description: -5o r <br /> FILE ADDRESS _ _ EHD USE ONLY <br /> $treat N Street Name - CityJ ❑ Unit 1 <br /> 2. ❑ unit 2 <br /> s. S�E _ <br /> una 3 <br /> 4. n <br /> 5. \� <br /> - - Unit pt_ <br /> 7. ._.......____._ ❑ UnaS <br /> 9. _ ❑ unit 6 <br /> 10. <br /> specific Date Range of Information Requested:From toDb $' <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Of UNbEROROUNO TANK(UST)CLEANUP SITE(LOP) 0 HOUSING ABATEMENT 0 SOLID WASTE FACILITYIVEHICLE <br /> Sr OTHER CLEANUP SITE(NON•LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 0 DAIRY <br /> ■HAZARDOUS WASTE GENERATOR E3 CHICKEN RANCH ❑WASTEWATER TREATMENT PLANT <br /> •TIERED PERMITTED FACILITY 0 MOTEUHOTEL 0 PUMPER TRUGKIYARDICNEMTOILEM <br /> 0 TAT rOOIBODY PIERCING 0 POOLISPA 0 LANG USE PLICATION$ITTFS <br /> In MEDICAL WASTE FACILITY IM OTHER(PLEASE SPECIFY) T_7t"TYnd�- ��OLS s1kt ,r <br /> WELLAND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW - MONDAY-FRIDAY8:OOAM•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 he selected. Fax to(209)464-0138 or mail/o the address indicated above. Address <br /> ranges will not be accepted-Tor 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 he <br /> submitted when the file is available. <br /> 4. Any Nle not returned in the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future Nle reviews by the same applicant may require a$95.00 deposit prior to review. <br /> EHD USE ONLY <br /> EHD"46 wag WWO07 <br /> TO/TO'd 8866 092 OTS 1:10 'ONUI>1130 dSN3 £T:ZT 8002-LZ-834 <br />