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01/11/2011 1B:40 <br />1 EGFJ V E <br />CMN 11 2011 <br />ENVIRONMENTAL HEATL*Iph <br />PERMIT/SERVICES <br />APPLICANT:�I�j l <br />ADDRESS: <br />PHONE (1);&�— <br />TENTATIVE" APP <br />(Please allow <br />❑ CHECK BOX TO EXP <br />SIGNATURE OF APPLIC <br />Electronic Information: <br />street # I <br />2. <br />3. <br />4. <br />6. <br />6„ <br />7. <br />8. <br />F110. <br />Specific Date Range of Information <br />eovNDERGROUND TANK (UST) CLEANI <br />THEIR CLEANUP SITE (NON -LOP) <br />) <br />DERGROUND TANK (MONITORING/ <br />AZAROOUS WASTE GENE;RATORCA <br />TICREO PERMITTF-D FACILITY <br />TATTOOIBODY PIERCING <br />MEDICAL WASTE FACILITY <br />WELL AND SEPTIC Pr-RMIT RECD <br />2576«999 <br />AEI CONSULTANT - <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL, HEALTH DEPARTMENT <br />600 East Main St. Stockton, CA 95202-3029 <br />)ne: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />PUBLIC RECORDS RELEASE APPLICATION <br />_a <br />9. LISt ua to ten addresses In th <br />box(es). At least one file typ) <br />ranges will not be accepted - <br />3:00 prn will be processed th4 <br />2. The EHD will notify the applic <br />days after receipt of applicati <br />should be scheduled accordi <br />3. A file that is actively being we <br />submitted when the file is ave <br />4. Any file not returned In the sa <br />Future file reviews by the sarr <br />S. If you need further assistance <br />BUSINESSIAGENCY: <br />PAGE 01/01 <br />EHD LOG NUMBER <br />,59193 <br />LD CITYtSTATE/ZIP: 4JM LL4:� <br />5 PHONE (2):� rid b I FACSIMILE: %4 0j 1 <br />INTMENT DATE ( Time; <br />i business days from data of application submittal . Tentative only - must be confirmed) <br />)ITE REQUEST - $115 FE (CA H HECK ONLY) - REQUEST PROCESSED IN 3 BU51NE55 DAYS <br />NT DATE Jj <br />_LLLVlj <br />List ❑ Map — Descriptlon: <br />FILE ADDRESS <br />Straet Name sky <br />1❑Unit�.. <br />110 <br />Inst 2 1 121 <br />init3 <br />nit 4 <br />nit 6 <br />Unit B <br />EN <br />:equegFrom to JZ <br />ENVIRONMENTAL HEALTH DEPARTMENT FILES <br />SITE (LOP) ❑ HOUSING ABATEMENTLID WASTE FACILITYNEHICLE q <br />❑ FOOD FACILITY WASTE TIRE <br />EMOVAL ❑ DOG KENNEL ❑ DAIRY <br />© CHICKEN RANCH ASTEWATER TREATMENT PLANT <br />❑ MOTEL/HOTEL PUMPER TRUCKIYARD/CHEMICAL TOILETS <br />❑ POOLISPA ❑ LAND USE APPLICATION SITES <br />❑ <br />OTHER (PLEASE SPECIFY) <br />RDS ARE AVAILABLE FOR REVIEW: MONDAY -FRIDAY 8:00 AM-5:OOPM (EXCLUDING HOLIDAYS) <br />space above. Select the type(S) of files from the list above by checking the appropriate <br />MUST be selected. fax10 209 464.0138 or mail to the address indicated above. Address <br />Dr additional assistance with file addresses, contact the EHD. Applications received after <br />next business day. <br />nt if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br />n. The files will be held for a maximum of five business days for review. Appointments <br />ked on by EHD staff may not be Immediately available for review. A new application may be <br />able. <br />is condition as released will be reorganized by EHD staff at the expense of the applicant, <br />applicant may require a $116 deposit prior to review, <br />please contact Diane Martinez, at (209) 468.3425, <br />rti/Ltro i <br />