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01/27/2011 12: 25 20933312303 LODI DOWNSTAIRS PAGE 02/02 <br /> • FHD LOG NUMBER <br /> R �NIED SAN JOAQUIN COUNTY <br /> fl ENVIRONMENTAL HEALTH DEPARTMENT <br /> IAN 2 S 2011 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> ENVIRONMENTAL HEALTH PUBLIC RECORDS RELEASE APPLICATION <br /> PERMITISERVICES , <br /> APPLICANT: <br /> --__TinaChe ley BUSINSSSIArFNCY: <br /> ADDRESS �„LU._902 TndustMl Way CitylStatelzlp [,Qdi, GA QF740 ? <br /> PHONE(1): - PHONE(2): FACSIMILE: <br /> TENTATIVE"APPOINTMENT DATE Plea$e 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; Ej List❑ Map-Description: <br /> FILE ADDRESS __., EHD USE ONLY <br /> Street iF Street Name _ City ❑ Unit 1 <br /> [4. <br /> 4051 Nevvton Road Stockton Un)t2 <br /> 3931 Newton_ Stockton...�F105 N. WilsonWanes_n2�S ...._Stockton <br /> 6. — <br /> Unit 5 <br /> g. - r_ ❑ Unit6 <br /> 10. <br /> Specific Date Range of Information Requested:From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> A ❑SOLID WASTE FACILITYNEHICLC <br /> UNOERGROUNp TANK(UST)CLEANUP SITE(LOP) M HOUSING ABATF.MFNT <br /> y� Cl FOOD FACILITY O WASTE TIRE <br /> ,gyp DTHER CLEANUP SITE MONFoRiN ❑DOG KENNEL 0 DAIRY <br /> .�AUNDERGROUNO TANK(MONnORiNGIREMDVAL) ❑CHICKEN RANCH O VUASTEWAWRTREATME14T PLANT <br /> )t HAZARDOUS WASTE GENERATOR ❑MpTELMDTEL 0 PUMPER TRUCKIYARDIGHEM TOILETS <br /> M TIERED PERMITTED FACILITY 0 POOLISPA 0 LAND USE APPLICATION SUES <br /> CI TATTOOIBODY PIERCING <br /> ❑MEDICAL WASTE FACILITY M OTHER(PI.F.ASF.SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW• MONOAY•FRIDAY 8:00 AM-5:001510 - 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 /> 60x(es). At least one file type MUST be selected. rac 209 464 0136 or mail to theaddress indiicatlons received atter <br /> � Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the EHD. App <br /> 3:00 pm will he processed the next business day. <br /> 2. The EHD r re notify the applicanttn. lf any EHD files exist. An The files will be held for a maximum ofointment f£Ive bus neSs days for review. <br /> Appointmr review will be confirmed ent n (10) <br /> days after receipt of app <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 he 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 /> PUBLIC RECORDS RELEASE APP FORM <br /> EHD 4846 $104108 <br />