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11/04/2011 14: 33 883680 PEM PAGE 01/01 <br /> RECEIVED r ► ► r <br /> LIATF Pr-rFIVFn SAN JOAQUIN COUNTY EHD LOG NUMBER <br /> I d 04 2011 ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH000 East Main 6t. StocKton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov,org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATI N . <br /> r <br /> APPLICANT: o pL BUSINESSIAGENCY: ya <br /> ADDRESS:/!5-o fl v c e '�CITY/STATEIZIP: <br /> PHONE(l): y -5 I a'� � PHCINE(2): FACSIMILE � � <br /> T TATIVE`APPOINTMENT DATE: Time; <br /> (Please allow 10 buoiness days fp6Nto of applioation oubm I RTonfativo only-muet be confirmod) <br /> ❑CHECK BOX TO EXPEDITE REQUES - C O C NLY)-REQUEST PROCESSED IN 3 BUSIN S Dy9S <br /> SIGNATURE OF APPLICANT DATF l <br /> Electronic Information: ❑ List❑ ap—Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street:r Street N - City Unfr 1 <br /> 2. 7..1� `� p _ Unit 2 <br /> -- <br /> 4. <br /> 5. 6 i � <br /> 6. t-1 jL—. ...._ nit4 <br /> 7. 11 <br /> 8. <br /> ❑Unit <br /> L110 <br /> V , nit6 <br /> Specific Data Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT OLIO WASTE FACILITYNEHIC <br /> THER CLEANUP SITE(NoN-LOP) ❑FOOD FACILITY ASTE TIRE <br /> NDERCROUNDTANK(MONITOnINCIREMOVAL) ❑Doc KGNNGL IRY <br /> HAZARDOUS WASTE GENERATOR ❑CHICKEN RANCH ElWASTEWATERTREATMENT PLANT <br /> IERED PERMITTED FACILITY ❑MOTELIHOTEL DUMPER TRUCKIYARDICHEMICAL TOILETS <br /> ❑ <br /> TATTOOIBODY PIERCING POOLISPA LAND USE APPLICATION SITES <br /> El MEDICAL WASTE FACILITY [I OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY B:00 AM-5:00PM(EXCLUDING HoL IDAY8) <br /> 1. List up to ten addogpF,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 typo MUST be selected. Fax to(209)464-0138 or mailLo tho addross indicated above. Address <br /> ranges will not be accepted-for additional aaaietance with filo addrasaca,eontaet the EHD. Appliontlonr.received after <br /> 3:00 pm will be processed the next business day. <br /> 2. The EHD will notify the applicant if any FHD files exist. An appointment for review will be confirmed approximately ten(10) <br /> days after receipt of application. The tiles will be held for a maximum of fiva business days fur 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 saie applicant may require a$122 deposit prior to review. <br /> ,D EHD USE ONLY <br /> 1s- <br /> #� <br /> 1 / <br /> EHD 40-06 07129110 <br />