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U,1/27/'2011 12:25 2093338303 LODI DOWNSTAIP.S PAGE 02/02 <br /> 4 • FHD LOG NUMBER <br /> R� WE SAN JOAQUIN COUNTY A <br /> ENVIRONMENTAL HEALTH DEPARTMENT f(go `p <br /> ii'N 2 S N11 600 Last Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 web: www,sjgov.org/ehd <br /> ENVIRONMENTALHEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMIT/SERVICES p�� <br /> APPLICANT: —Tjna C-he )e OUSINESSIAGENCY: <br /> ADDRESS _902 IndU$ ri 1 Way cityistatelzip -LQ " 10 <br /> PHONE(1): PHONE(2): FACSIMILE: -4933 -8303 <br /> TEMTATIVE*APPOINTMENT DATE: Please call Time: <br /> (Please allow 10 business days from date of Application submittal-"Tentative only•must be confirmed) <br /> ❑ CHECK BOX TO EXPEDITE REQUEST-$105 FEE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT _ DATE 1-28^11 <br /> Electronic Information: ❑ List❑ Map-Description: <br /> FILE ADDRESS EHD USE ONLY <br /> Street 9 Stroot Name _ _ City [] Unit 1 <br /> 1• 4051 Newton Road Stockton Fj <br /> 2. 3931 Newton_Road _' .: _ Stock—to—n - <br /> 3. <br /> tockton _ ""2 <br /> 3. 4105 N. Wilson Waw_�:Y,�� ....Stockton UnH3 <br /> 4 <br /> 5 <br /> T _.�.__..,_. ....-_ ❑ Unit 5 <br /> 8.� <br /> g, _ ❑ Unit 0 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> �( ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> �y..+��,UNDF.ROROUNP TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATEMENT ❑SOLID WASTE FACILITYNEWCLE <br /> � OTHER CLEANUP SITE(NON^LOP) 0 FOOD FACILITY 0 WASTE TIRE <br /> XUNDERGROUND TANK(MONITORINGIREMOVAL) 0 DOG KENNEL 171 DAIRY <br /> HAZARDOUS WASTE GENERATOR CICHICKEN RANCH O WASTEWATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY 0 MOTELIHOTEL 173 PUMPER TRUCKIYARDIGHEM TOILETS <br /> 0 TATTOOIBObY PIERCING ❑POOLISPA 71 LAND USE APPLICATION SITES <br /> 13 MEDICAL WASTE FACILITY O OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW- MONDAY.FRIDAY 8:00 AM-5:0OPM -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 thI.sIdsiress 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 he 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 /> EHD 48.66 8I04rtla ---PUBLIC RECORDS RELEASE APP FORM <br />