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01/05/2011 15: 49 92574GC `I AE1 CONSULTANTS , PAGE 01/01 <br /> ;x tJ <br /> m E� VE SANEHD LOG NUMBER <br /> �,�DAQl11N COUNTY <br /> JAN Q 5 2011 ENVIRONMENTAL HEALTH DEPARTMENT 0 7 <br /> 600 EaSt Main St. Stockton, CA 95302-3029 <br /> Telephone: (209)468-3420 Fax: (209)46470138 Web. www_sjgaV:arglehd <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT: N trig - - BUSINESS/AGENCY. AVI (`el�SraL f fTS <br /> ADDRESS: 0-bl __—. CITYISTATEIZIP:WA-V [,(Jk <br /> PHONE(11): <br /> (jggbq�6---{• L I _ PHONE(2): FACSIMILE: <br /> TENTATI VE"APPOI NTM ENT DATE: Tirne: <br /> tpleaso allow 1D businoas days from date of application submittal-`Tantattve only-must he confirmed) <br /> �] CHECK 60k TO EXPEDII-E REOLIE5T-$115 FEE( AR K ONLY)-REQUEST PROCESSED IN 3 6USINE55 DAYS <br /> SIGNATURE OF APPLICANT 4 DATE <br /> Electronic Information- ❑ List❑Map—pescript+on: <br /> _ FILE ADDRESS EHD UUE ONLY <br /> Street A - Street Name City Ej Unit 1 <br /> 1. � f rA6 $ L of _ <br /> 2. STDs 0J ❑Unit2 <br /> 4: �� �1'��[4LI� t�fs� -- 0, 0� . .._.__ Vnit3_ <br /> b. <br /> (i. <br /> 7. <br /> 8. <br /> ILI Unit S <br /> Un#6 <br /> Specific Data Ranya eT Into... tic?"Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES <br /> Fr;NOERGROUND TAMC(UST)CLEANUP SUE(LOP) ❑HousiNG ABATEMENT QLIO WASTE FACILITY/VEHICLE <br /> THER CLEANUP SITE((VON-LOIS} ❑FO40 FACILITY WASTE TIRE <br /> I)ERGROUND TANK(MONITORwGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AIAHDOUS WASTE GENERATOR ❑CHICKEN RANCH ❑WA5TEINATER TREATMENT PLANT <br /> ❑TIERED PERMITTED FACILITY ❑MOILLIHOTEL ❑PUMPER TRUCKNARDIG HEMIGAL TOILETS <br /> W❑ ATTGOIBODY PIERCING ❑.P000SPA F1 LAND UsE APPLICATION SITES <br /> MEDICAL WASTE FACILITY Q OTHER(PLEASE SPtC11=Y) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONQAY-FRIDAY B.,00 AM-5:04PM 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. », <br /> !=a)iJ9(999)494-0738 or mail Co the tlddre99 indicated above. Address <br /> ranges will not be accepted-for additIonal assistance with flle addresses,contact th®EHL). Applications received after <br /> 3:60 pm will be processed the next business day. i <br /> 2. The EHU will notify the applioant 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 maxlrnum 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 Immedlately 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$116 deposit prior to review. <br /> 5. If you need further assistance,please contact Diane Martinez,at(209)468.3425, <br /> 6 FIb.49-GS <br /> erat'rua i <br />