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RECEIVED AN JOAQUIN COUNTY EHD LOG NUMBER <br /> Eli,IRw�NMEN7 <br /> OCT 19 Z011 Atw HEALTH DEPARTMENT <br /> 6OU East Main St. Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www,sjgov.org/ehd <br /> ENViROWhENTAL HEALTH <br /> PERMIT/SERVICES <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT; BUSINESS/AGENCY: AF, ( �oi/ISUI�cth� 5 <br /> ADDRESS: ;1 dna C Ikw vo o D\olwlo CITY/STATE/ZIP: WaGNua QyeN.k�< 11, 4- `(_4S9$ <br /> PHONE(1): (j25 j 1— 19(3 PHONE(2); FACSIMILE: <br /> TENTATIVE*APPOINTMENT DATE: (C,(2-4, ( iia(( Time: <br /> (Please allow 10 business days from date of application submittal-'Tentative only-must be Confirmed) <br /> ❑CHECK BOX TO EXPEDITE REQUEST-$ 25 FEE(CASH OR CHECK ONLY)•REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT DAT! <br /> Electronic Information: ❑List❑ Map-Description: <br /> FILE ADDRESS EMD USE ONLY <br /> Street# Street Name City n- Unit 1 <br /> 1. -Z.D 2-0 Q5't M i vt e)r Ave- <br /> 2- <br /> ({ve.2- 2 zoo ecoi- K vi e r -acv,e, Stu c.V­m A Gp <br /> Unit2 <br /> Unita <br /> t3. ! <br /> Unit 4 <br /> 7. <br /> 8. <br /> jnI <br /> SWIfic Date flange of Information Requested: From A�Q _ to (� <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILE$ <br /> UNDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT ®SOLID WASTE FACILITYNEHICLE <br /> OTHER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY ®WASTE TIRE <br /> ®UNDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL DAIRY <br /> HAZARDOUSWASTE GENERATOR ❑CHICKEN RANCH WASTEWATER TREATMENT PLANT <br /> TIERED PERMITTED FACILITY ❑MOTELIHOTEL PUMPER TRUcKNARDICHEMICAL TOILETS <br /> TATTOO/BODY PIERCING ❑POOL/SPA ,®LAND USE APPLICATION SITES <br /> [4 MEDICAL WASTE FACILITY COMPLAINT RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-5:00PM(EXCLUDING HOLIDAYS) <br /> 1. t,lat 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 12091464-0138 or mail to 11:19,address indicated above Address <br /> ranges will not be accepted-for additional assistance with file addresses,contact the END. Applications received after <br /> 3:00 pm will ba 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 wonted 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 raturned 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$125 deposit prior to review. <br /> eHD ueE OWY <br /> EHD 40-06 aNl11 <br /> T /T "30F>:d NV 9C:60 TT0Z•6T'g00 <br />