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Aug. 10. 2011 08 : 59 "ESTON SOLUTIONS INC OAKL 5108919710 PACE. l� 1 <br /> RECEIVE <br /> DATE RECEIVED EHD LOG NUMBER <br /> Q Cp��� O 2011 SAN .10AQUIN COUNTY <br /> / ENVIRONMENTAL HEALTH DEPARTMENT <br /> ENVIRONMENTAL HEALTH 600 East Main St. Stockton, CA 95202-3029 <br /> PERMIT/SERVICES Telephone; (209) 468-3420 Fax: (209) 464-0138 Web: wv✓w.sjgov.org/ehd <br /> PUBLIC RECORDS RELEASE APPLICATION <br /> APPLICANT:(_ t�f�J BUSINESS/AGENCY:WX�&[V�q%,, <br /> ADDRESS: (� ` (q�`{t ld�Gv,( �"� CITY/STATE/ZIP: �(iuQ, <br /> PHONE(1); li)* $ "2£(0�' PHON�( 2 FACSIMILE": <br /> TENTATIVE*APPOINTMENT DATE: i�1���y61( Time: <br /> (Please allow 10 business days from data of ppllcatl0n Submittal-"Tentative only-must he confirmed) <br /> ❑CHECK BOX TO EXPEDITE REMu;-- <br /> EE(CASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE~OF APPLICANT DATE <br /> Electronic Information: ❑List❑Map—Description: <br /> FILE ADDRESS <br /> R9 <br /> FILE <br /> Street# Street Name City y <br /> Ij U I ❑Unit 1 <br /> 2. <br /> '12r&It 2 <br /> 3 <br /> 4. <br /> -I----- ------------ it 3 <br /> 6. <br /> 6 I <br /> 7. <br /> $' I ❑Unit 6 <br /> 10. B Unit e <br /> Specific Date Range of Information Requested: From X to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �,, <br /> NDERGROUND TANK(UST)CLEANUP SITE(LOP) ❑HOUSING ABATEMENT OLID WASTE FACILITYNEHICJ <br /> THER CLEANUP SITE(NON-LOP) ❑FOOD FACILITY WASTE TIRE 0 <br /> NDERGROUND TANK(MONITORINGIREMOVAL) ❑DOG KENNEL ❑DAIRY <br /> AZARDOUS WASTE GENERATOR F] <br /> CHICKEN RANCH STEWATER TREATMENT PLANT <br /> ERED PERMITTED FACILITY ❑MOTEUHOTEL ZPUIND <br /> MPER TRUCK/YARDICHEMICAL TOILETS <br /> ❑TATTOO/BODY PIERCING ❑POOL/SPA UsE APPLICATION SITES <br /> ❑ MEDICAL WASTE FACILITY ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 8:00 AM-6:00PM(EXCLUDING HOLIDAYS) <br /> 1. List vo 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 the address ind gAted 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 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 same applicant may require a$122 deposit prior to review. <br /> EHO USE ONLY <br /> EHD 40-06 _.D7129110 <br />